Hormones, Wrinkles and Aging Skin

We all understand that hormone problems can cause symptoms like hot flashes or PMS, but did you know that hormone imbalances cause wrinkles too?

What do hormones have to do with wrinkles and aging skin? 

Just the sound of those words can make us cringe. I don’t mind getting older at all.  I am wiser.   But the looking older part, well I just don’t care for that at all. We all realize and face the fact that we will age and we will get wrinkles due to what is called chronological aging. We also know that we can certainly speed up the aging of our skin from what is termed environmental aging, due to sun damage, tanning, etc. So ladies, if wrinkles and skin aging must happen, I certainly don’t want it to happen rapidly or any sooner than necessary.  How about you? In this newsletter, I want to share with you insight on which hormone imbalances trigger and can accelerate what some experts call hormonal aging of our skin.

Hormones affect every single cell in our bodies so of course they affect our skin too. Hormone imbalances can also lead to more than just aging skin, they can cause: thinning skin, dehydrated, dry, sensitive skin, decreased elasticity and firmness, flushing, uneven skin pigmentation, occasional itchiness, breakouts and photosensitivity.

It is All About Collagen, Elastin, and Hyaluronic Acid 

To begin, we need to review the 3 basic components that keep our skin youthful: 

1.  Collagen- a protein found in the skin, bone, cartilage and tendons, which acts like rope to give our skin strength and prevent sagging.  After age 30, we lose 1 percent of our collagen a year.  Studies show that skin loses up to 30% of its collagen over the first five years following menopause. 

2.  Elastin - acts like rubber bands and gives our skin elasticity and “bounce back.” 

3.  Hyaluronic Acid - keeps our skin plump and hydrated. Aged skin, which is less plump than youthful skin, is characterized by decreased levels of hyaluronic acid.

Our hormones are directly responsible for the production and maintenance of these three components of our skin. 

Estrogen and Aging

Let’s cover the effect of hormones on collagen, elastin, and HA starting with estrogen.  Estrogen is necessary for the production of collagen, elastin, and HA.   The skin on our face has a high concentration of estrogen receptors, which means these receptors are meant to receive normal amounts of estrogen. Declining estrogen or a deficiency of estrogen causes less collagen and elastin production which means more wrinkles, fine lines, less eslasticity and firmness. Additionally, declining hyaluronic acid due to lower estrogen levels mean less moisture in our skin.  Aged skin can appear paler because the lack of estrogen reduces the number of blood vessels in the skin affecting vascularity.  Low estrogen also causes increased skin pigmentation.

What I am about to share next is not good news!  A study found that the skin of women with low estrogen levels looked significantly older than their age, and those with more optimal levels looked much younger than their age.  Those with the lowest level of estrogen looked 8 years older than their age and those with the most optimal levels looked 8 years younger than their age.¹

I do have some good news!   Several studies have shown that estrogen replacement therapy has had beneficial effects on collagen content and skin thickness.  Even HRT has been shown to prevent dry skin and wrinkling, but I certainly don’t recommend synthetic or animal derived hormones for any reason. Postmenopausal women using estrogen were 1/3 less likely to develop skin wrinkles, according to one study.  Bioidentical (natural) estrogen replacement has been shown to improve collagen levels and moisture content of the skin and reduce wrinkles.

Here is more good news: application of bioidentical estrogen face creams has been shown in a couple of studies to cause a marked improvement in fine wrinkles. Estrogen face cream caused increase in collagen, elastin and HA.^{2 ,3,} Researchers in one study used estradiol and estriol face creams on women. After treatment for 6 months, elasticity and firmness of the skin had markedly improved and the wrinkle depth and pore sizes had decreased by 61 to 100% in both groups. Furthermore, skin moisture had increased and the measurement of wrinkles revealed significant, or even highly significant, decreases of wrinkle depth in the estradiol and the estriol groups, respectively. On a side note, both HRT and bioidentical topical estrogen replacement substantially accelerates skin healing in elderly humans.

Progesterone and Wrinkles

Estrogen is not the only hormone that affects collagen and elastin. Progesterone also helps prevent collagen breakdown and stimulates collagen and elastin production. Progesterone applied on the face has been studied too. Researchers found that applying progesterone cream on the face in peri- and postmenopausal women for 16-weeks demonstrated a 29% reduction in wrinkle counts and almost 10% reduction in wrinkle depth around the eyes (that would be crow’s feet), almost 10% decrease in nasolabial wrinkle depth (the smile line) and 23% increase in skin firmness.⁵

Phytoestrogens and Wrinkles

Phytoestrogens are plant-derived molecules that are similar to endogenous (produced by the body) hormones.  Soy is one common phytoestrogen.  Studies have demonstrated that genistein found in soy, may prevent sun related aging in human skin. Other studies have reported that genistein and daidzein stimulate hyaluronic acid production. One study conducted on a cosmetic cream preparation including isoflavone showed improvement in the skin dryness and wrinkles after 12 weeks of treatment.⁶

How do you get these hormone creams for your face? 

Talk to your BHRT physician or pharmacist if you are using BHRT creams.  You may be able to use your prescription on your face or your physician can prescribe one for you.  You may even be able to use some over-the-counter progesterone creams on your face.  Be aware that if you are using hormones on your face this will interfere with saliva hormone testing.  When your doctor orders this type of hormone testing you should not use hormones on your face for two weeks prior to taking the test or check with the lab or your doctor.

Androgens and Wrinkles

Testosterone levels can decline with age or abruptly with removal of the ovaries. Since testosterone is a hormone that is anabolic (tissue building), it affects the structural integrity of the skin.  If testosterone is low, the deepest layers of our skin will start to thin and sag. Thinning skin can be very noticeable on the back of the hands too.  We have all seen the hands of elderly people that appear papery thin and don’t heal very fast from cuts. 

Other Hormones and the Skin

Other hormones that also affect our skin are thyroid and the adrenal hormone cortisol.  When your thyroid function is low, skin becomes dry and scaly.  Since Cortisol is catabolic, which means to break down, elevated cortisol may also trigger more rapid wrinkling. 

Prevention

We think about applying sunscreen to protect our skin.  We use our day creams and night creams that claim to make us look younger.  Some of us have utilized injectables and other medical procedures as a means of addressing wrinkles.  There isn’t anything wrong with any of these.  A woman’s got to do what a woman’s got to do!  However, maybe we would spend less money on facial repair if we also focused on preventing and slowing the wrinkling process by making sure we have optimal levels of hormones. We eat right, exercise, and take supplements to prevent things like heart disease. It is much easier to hold on to what you already have, than try to try to get that youthful appearance back.  So, let’s do our skin a favor and make sure it has the hormones it needs too.

1 Lancet. 1999 Jul 17;354(9174):224. Wildt L, Sir-Petermann T.

Oestrogen and age estimations of perimenopausal women.

2 Int J Dermatol. 1996 Sep;35(9):669-74. Schmidt JB, Binder M, Demschik G, Bieglmayer C, Reiner A. Treatment of skin aging with topical estrogens.

3 Exp Dermatol. 2004;13 Suppl 4:36-40. Sator PG, Schmidt JB, Rabe T, Zouboulis CC. Skin aging and sex hormones in women -- clinical perspectives for intervention by hormone replacement therapy.

4 Biogerontology. 2011 Mar 3. Emmerson E, Hardman MJ. The role of estrogen deficiency in skin ageing and wound healing

5 Br J Dermatol. 2005 Nov;153(5):1092. Schmidt, JB. Effects and side-effects of 2% progesterone cream on the skin of peri- and postmenopausal women: results from a double-blind, vehicle-controlled, randomized study.

6 Climacteric; Aug 2007; 10, 4; Health Module pg. 289 S Verdier, Sévrain. Effect of estrogens on skin aging and the potential role of selective estrogen receptor modulators.

The Hormone Connection to Weight Gain

Hormones and Weight Gain

 Most every woman I know is concerned about loosing weight or at least maintaining her waistline. Some women have faced weight issues since childhood while others find themselves struggling with weight as they move into the their late 30’s and 40’s.

 What do hormones have to do with metabolism?  What do hormones have to do with fat storage and weight gain? 

 Everything! We all know that exercise and what we eat affects our weight and the rate at which we burn calories.  But what is the problem when you are eating right and exercising but not getting the results you deserve?  If this is you, then it's time to consider that the hinderance could be due to a problem at a deeper level within your biochemistry:  your hormones. Having worked in medical practices specializing in bioidentical hormones for the past decade, I have sat across the desk and heard countless heart wrenching stories of women’s frustrations with their metabolism.  Many have fought using diet and exercise with out significant success for so long that they have just given up.  Too many women struggle needlessly because they just do not know that certain hormone imbalances are working against their efforts. The good news is that the underlying hormone imbalances that trigger weight gain can be corrected.

 Which hormone imbalances cause weight gain?

 The answer to that is easy; any hormone that is out-of-balance can cause us to gain weight. Since it is obviously more complicated than that, I want to break it down by each hormone.  As I proceed, it is important to remember that insulin is considered the fat storage hormone. Insulin is produced by the pancreas in response to a rise in blood glucose (also called blood sugar). Its function is to take nutrients from the blood stream and store them in body cells.  Problems arise if we consume too much sugar or starches.  If so, we must make more insulin to drive the glucose into the tissue.  Also, our cells can become resistant to insulin therefore excess insulin may be circulating and guess what? We readily store fat.

 How can we manage insulin?

 The solutions to excess insulin and/or insulin resistance are; 1) eat low glycemic foods which means no sugar or starches, 2) try supplements that support insulin utilization (under the care of your physician) such as:  chromium, cinnamon, coffee berry, acetyl-carnitine, alpha lipoic acid, fish oil, etc., and 3) balance other hormones that are associated with insulin resistance.

 What other hormones cause weight gain?

 Imbalances in any of the hormones including estrogen, progesterone, testosterone, DHEA, cortisol, and thyroid can lead to weight gain.  Imbalances in these hormones can also trigger insulin resistance, which in turn, sets us up for fat storage.  We must balance the other hormones to combat the insulin fat storing effect.

 How does progesterone affect metabolism?

 Progesterone is the first of the reproductive hormones that starts to change, typically declining to low levels by the mid-thirties.  It plays a role in metabolism in several ways. 

• Progesterone, at normal levels, helps us burn calories instead of storing them as fat due to its thermogenic properties.
• Progesterone helps facilitate thyroid hormone utilization – that simply means progesterone helps carry your thyroid hormone into its receptors where it carries out its actions.  Thyroid hormones affect the rate at which we burn calories.
• Progesterone balanced properly with estrogen also helps our thyroid function by helping convert thyroid hormone T4 into its more usable form, T3. A lack of adequate progesterone to balance your estrogen, called Estrogen Dominance, blocks the actions of thyroid hormones at the cellular level causing symptoms of low thyroid including weight gain.
• Proper levels of progesterone regulate insulin, if we are Estrogen Dominant, we tend to have more frequent and a more rapid release of insulin putting us in fat storage mode.
• Water weight gain prior menstrual cycles can be due to low progesterone since it is a natural diuretic.

 The solution –make sure you have a normal level of progesterone through saliva hormone testing and taking progesterone if indicated.

 How Does Estrogen Affect Weight?

 Estrogen also affects our metabolism.  Some women think that estrogen causes weight gain and that just is not the case.  However, I can see why women may get that confused.  One of the side effects of HRT is weight gain. Actually an estrogen deficiency leads to weight gain. You see, estrogen increases the sensitivity of muscle and fat to insulin thereby helping lower insulin and reduce the fat storing affect of insulin. There is something estrogen does too; it helps stimulate lipoprotein lipase, which is an enzyme that breaks down fat. By the way, estrogen deficiency also triggers carbohydrate cravings. On the other hand, excess estrogen is associated with insulin problems. 

 The solutions – make sure your estrogen level is normal but also remember that estrogen fluctuates during the menstrual cycle.  Some times you have to just modulate estrogen levels and not necessarily increase estrogen.  You will need to take this up with your BHRT physician.

 There is one more thing I need to say about low estrogen and weight gain.  Research has now shown that women with low estrogen have higher levels of the stress hormone cortisol, which leads us to a very important part of this discussion. 

 What is the cortisol connection to weight gain?

 Yes, cortisol can be elevated from low estrogen, but that certainly isn’t the only cause and you don’t have to have low estrogen to have high cortisol. Stress causes elevated cortisol which leads to weight gain, in particular abdominal weight gain.

 In fact, deep abdominal fat contains up to 4 times the number of cortisol receptors than other areas of the body. That means the abdomen is more likely to respond to elevated cortisol.  Unfortunately, the abdominal tissue responds by storing fat.  What makes this even worse is that women with excess abdominal weight secrete more cortisol when stressed. Elevated cortisol also triggers food cravings. You have probably noticed that when you are stressed you want something munch on.

 Chronically high cortisol is caused by stress.  We know of course that stress is related to psychological and circumstantial situations, but other stressors affect our cortisol too including: blood sugar fluctuations, nutritional deficiencies, chronic bacteria or virus, chronic pain, chronic lack of sleep, food sensitivities, etc. You get it, any thing that stresses your body can lead to high cortisol. 

 What are the effects of cortisol on other hormones and weight gain?

 Aside from directly triggering abdominal weight gain, chronically elevated cortisol causes some real problems that in turn indirectly affect our weight.  High cortisol blocks every other hormone from getting into their receptors and carrying out their function.

 High cortisol:

• blocks thyroid hormone from getting into its receptors,
• blocks estrogen from its receptors,
• depletes our progesterone,
• causes insulin resistance which leads to fat storage,
• causes food cravings.

 What is the solution to high cortisol?

 First of all, you should have your cortisol tested through saliva testing to make sure that it actually is elevated.  Your BHRT physician can help you with this.  If indicated there are supplements that help lower cortisol such as:  Phosphorylated  Serine, theanine, rhodiola, etc. Stress reduction lifestyle changes may help as well.

 What about the androgens: DHEA and testosterone?

 The androgens: Testosterone and DHEA also affect our weight too.  Both of them help our body utilize insulin properly so we don’t store fat.  Therefore, deficiencies can cause weight gain and make it hard for you to loose. On the other hand, testosterone and DHEA can become elevated due to insulin resistance. Once again, hormone testing and balancing can address these imbalances. 

 What about low thyroid and weight gain?

 Even a slight suboptimal thyroid deficiency can affect your metabolism since thyroid function affects the rate at which we burn calories. Doctors have different opinions about thyroid testing.  If you have any of the common symptoms low thyroid function such as weight gain, low body temperature, fatigue, hair loss, low mood, dry skin, etc., you can learn more about low thyroid and thyroid testing by listening to the, “Hormone Makeover Chat,” podcast from August 23,^, 2011.  It is free to listen to on my website www.donnawhitehormonemakeover.com (click on the “Resources” tab, then “Chat” from the drop down menu) or you can down load it free from itunes.

 Do not let your hormones hold you back!

 If you have been struggling with maintaining your weight, or if you are struggling to shed a few or a lot of pounds please consider that hormone imbalance may be holding you back, especially if you are doing everything else right.  If this is your struggle, get yourself a hormone makeover. You deserve the rewards of balanced hormones.

 More resources for you.

 I invite you to visit my website to review the symptoms of each different hormone imbalance.  Click on the Symptoms tab.  You can review past podcasts and down load the first two chapters of my book, “The Hormone Makeover – 7 Steps to Transform Your Life with Bioidentical Hormones”, for free. While you are there, if have not signed up for my newsletter please do so to keep up with all events and articles.

Introducing the Hormone Makeover Free Weekly Chat

Do you want to learn more about hormones? Are you interested in learning how to overcome hormone imbalances so you can have more energy, better sleep, improved mood and libido, increased brain function, loose weight, get rid of PMS or menopausal symptoms?



Now you can learn about these challenges that women face at no charge!  Join Donna White each week for The Hormone Makeover Chat, a FREE weekly teleconference designed  for women of all ages wanting more information about hormones and issues related to hormone imbalance including PMS, perimenopause, and menopause.  The Hormone Makeover Chat is held every Tuesday at 12 noon Eastern Standard Time.  Calls last 30 minutes including time allowed for listener questions at the end of each call. 

How to Join in on the Fun!

  

Listening in on the calls is easy.  No registration required and no fees.  Simply call the conference dial-in number: (712) 432-0900 just before 12 noon Eastern Standard Time.  Use the Participant Access code: 920928.  (Please note: your regular phone long distance charges or cell phone minutes apply.)

Conference Phone Number: (712) 432-0900

Participant Access Code: 920928

You are welcome to submit your questions prior to the call on The Hormone Makeover Fan Page. You may also ask questions on the call as time permits.  If you cannot join at noon, simply listen at your leisure.  All calls will be recorded and available for replay at www.donnawhitehormonemakeover.com and posted on The Hormone Makeover Fan page.

(Please note that the host, Donna White, BHRT Clinical Educator, cannot give medical advice.)

There is no need to sign up ahead of time. Just call in just before 12 noon, EST.  If you would like an email reminder the morning of the call, simply reply to this email.

Topics of discussion will include the hormone connection to:    ·       Weight gain and metabolism ·       Fatigue ·       Insomnia and sleep disturbances ·       Low sex drive ·       Bone loss ·       Hair loss ·       PMS ·       Heavy or irregular periods ·       Hot flashes and night sweats ·       Anxiety and depression ·       Many more frustrating symptoms

Women will learn:    ·       The causes of hormone problems and when they    typically occur during the course of a woman's life ·       The difference between synthetic hormones, over-the-counter herbal products and bioidentical hormones ·       The role each hormone plays in the body ·       How to find and work with a physician ·       How physicians use bioidentical hormones to correct hormone imbalance ·       The research supporting bioidentical hormones ·       Hormone testing ·       Thyroid hormone problems ·       Stress (adrenal) hormone imbalances ·       Nutrients that affect hormone balance and bone building ·       And much more including the solutions for hormone imbalances!

Schedule of Topics:     We want your feed back. Tell us the topics you are interested in learning about and submit your questions.  We will plan our weekly schedule based on listener input.  Please share all topic suggestions and questions on the Facebook fan page.  June 21 - The Symptoms Associated with Hormone Imbalance and When They Typically Occur June 28 - Options to Addressing Hormone Imbalances (over-the-counter products, medications, natural/bioidentical hormones) July 5- Should You Test Your Hormones?

About the Host:  Donna White BHRT Clinical Educator, Author and Speaker Donna has helped thousands of women with Bio-identical Hormone Replacement Therapy  over the past 18 years by working along side physicians including Dr. Dino Kanelos, in Charlotte, NC, Dr. Larry Webster and Dr. Julius Torelli in High Point NC and currently with Deborah Matthew, MD, at Signature Wellness Center for Optimal Health in Charlotte, NC.  Donna has traveled across the U.S., training medical practitioners in how to prescribe and implement BHRT in their medical practice. She has spoken at numerous medical conferences on BHRT for physicians and compounding pharmacists. Donna is nationally known women's conference speaker and author of the book, "The Hormone Makeover-7 Steps to Transform Your Life with Bio-Identical Hormones".

More Events and Specials to Come!

I am also excited to annouce that in the very near futre I will be hosting ELearning Workshops and an ELearning Series all about hormones!

  

If you have not read my new book, "The Hormone Makeover - 7 Steps to Transform Your Life with Bioidentical Hormones", I invite you to go to my website and down load the first 2 chapters for free.

Sincerely,

Donna White

Donna White Hormone Makeover

Please double click on video to watch in full screen.

Could It Be Your Hormones?

(This blog was published on 4/19/2010 on http://www.proverbs31.org/, a daily devotion sponsored by Proverbs 31 Minitries.)

Hormones are powerful and so are the symptoms of imbalance!

I am so thankful to Melanie for sharing about hormones on your devotion blog. Hormones are very powerful substances. They have actions in every single cell of our body, not just our reproductive system. Hormones absolutely do affect our physical health, weight, skin quality, bone health, brain function, quality of sleep and most definitely our mood and emotions. God created these potent chemicals called hormones for our good, to give us energy, vitality and the power to walk in divine health. But He intended that we have balanced hormones.

We all know that hormonal changes occur during various phases of our lives and that is normal. However, God did not create PMS or plan for peri-menopause or menopause to be turbulent. We do live in a fallen world and there are many factors that can lead to hormone imbalance and its accompanying symptoms. Stress, nutrition, genetic factors, thyroid problems, blood sugar imbalances and certain medications can all trigger imbalances in our hormones.

Hormone imbalance even affects mighty women of faith and power.

I have to say that hormonal imbalance directly impacts Christian women on a spiritual level. Too many times, I have sat across the desk from a sister-in-the-Lord and heard her agonize over the way her monthly pre-menstrual moods are impacting their children or listened as they beat themselves up for feeling depressed. They assume that they are just not reading the Bible enough, praying enough or walking in the fruit of the Spirit. Sometimes, these emotional flare ups are simply due to hormones. Trust me; hormone levels do affect our relationships with each other and with God. He created our bodies and He intended that certain biochemical hormone processes take place in order to walk in health.

I saw first hand the impact of hormones on Christian women globally last year at the “She Speaks” Conference. It is so evident that God is launching women into their ministries and callings like never before. I believe that God confirmed to me that His women need to feel good to fulfill their destinies. We as Christian women do put our faith and trust in God. However, we do live in this physical world and have a physical body governed by God ordained metabolic processes. We need our energy levels to be good, our sleep to be refreshing and our moods stable to accomplish His purposes. Of course there are many aspects of physical health, but sadly most women do not even realize that issues they face could in fact, be related to hormone problems. My calling is to make sure that God’s precious daughters know about the symptoms of hormone deficiencies or excessive levels of hormones and how to correct them so that God can launch them into their purposes.

Is it you or your hormones? (Signs or Symptoms related to hormone imbalance)

So how do you know if you are experiencing symptoms due to a lack of balanced hormones? First let me point out that hormonal imbalance can occur at any age, from young teens to post-menopausal or elderly women. Symptoms can range from reproductive/gynecological problems, physical health problems and yes, emotional or mood challenges. I should know. I got into this field 18 years ago due to my own severe case of PMS. In Christian terms, that means Pretty Mean Sister. God took my “mess” and turned it into my “message” of His hope and being hormonally healthy.

Here is a check list to help you determine if you should have your hormones evaluated:

Physical Symptoms:
 Weight Gain
 Hot Flashes
 Night Sweats
 Fatigue
 Headaches
 Migraines
 Hypothyroidism
 Hair loss
 Allergies/Sinusitis
 Bone Loss
 Insomnia
 Low body temp
 Foggy thinking
 Heart Palpations
 Dry Skin/ Hair
 Elevated Cholesterol
 Elevated Triglycerides
 Thinning Skin
 Fibromyalgia
 Acne/Oily Skin
 Facial Hair
 Constipation
Reproductive Symptoms:
  Breast Pain
 Breast Cysts
 PMS
 Fibroids
 Heavy Cycles
 Irregular Cycles
 Spotting
 Endometriosis
 Cramps
 Vaginal Dryness
 Breast Cancer
 Yeast Infections
 Urinary Tract Infections
 Water Retention
 Thinning Pubic Hair
 Incontinence
 Infertility
 Miscarriage
 Ovarian Cysts
Emotional Symptoms:
 Anxiety
 Depression
 Irritability
 Stressed Easily
 Low Sex Drive
 Mood Swings
 Over Reacting
 Easily Alarmed
 Confusion
 Mood swings
 Nervous/Jittery
 Food Cravings

We can gain victory and overcome hormone challenges.


The first place to start is to get wisdom and truth. This involves education and in many cases testing. There are very specialized tests that can definitively determine hormone levels. Hormones do not have to be confusing nor should we be afraid of hormones. God made them to bless us.

Secondly, get help. Do not just put up with hormone imbalance and live a life less than you deserve. There are well-trained experts in the field of hormone balance and quality science based educational resources for women. You may need to restore deficient levels of hormones with natural, bio-identical hormones. These hormones are the same hormones that God created and our bodies produce. They are exactly the same. Not that we need to prove that the hormones God created are effective and safe but of course the medical community operates from scientific research. There is a large body of published medical studies on bio-identical hormones. In fact, 1/3 of my book is just that, a bibliography of the studies on bio-identical hormones. (Synthetic hormones, such as in Hormone Replacement Therapy, HRT, or in birth control pills have been clearly proven to cause side effects. We should not be surprised. How can we improve on the hormones that God created?) You may also need to take certain supplements that help address stress hormone imbalance or to help balance blood sugar. Many women do need some form of thyroid treatment. Regardless of whatever type hormone imbalance or symptoms you may have, you do not have to live with hormone problems! There is hope and there is help.

In Christ,

Donna White
BHRT Clinical Educator, Signature Wellness
Speaker
Author, “The Hormone Makeover- 7 Steps to Transform Your Life with Bioidentical Hormones”

Resources
http://www.donnawhitehormonemakeover.com/
http://www.facebook.com/TheDonnaWhiteHormoneMakeover
hormonemakeover.blogspot.com
http://www.signaturewellness.org/