Symptoms of Menopause: When Sex Hurts


At the time of menopause, women who had previously enjoyed sex may develop vaginal dryness and pain with intercourse. They may also experience difficulty achieving orgasm. A milder version of this can occur in perimenopause, the time interval that precedes menopause. Perimenopause can last for three months or as long as ten years before menopause. The age at which natural menopause occurs tends to be similar to that of your mother.

Continue reading Symptoms of Menopause: When Sex Hurts

Cabbage Crunch

Cabbage CrunchCabbage is one of the most potent medicinal foods available, with almost 500 studies demonstrating its cancer-preventive and anti-inflammatory properties.Get Help with High Medication Prices

It grows during late fall through winter, making it a perfect and inexpensive choice for cold-weather meals. This versatile vegetable can be added to salads or mixed into fresh vegetable juice.
What many people love most about cabbage is its crunchiness – here’s one way to enjoy it without losing its “crunch factor.”


½ head red cabbage, chopped finely
½ head white cabbage, chopped finely
½ cup scallions, chopped
½ cup cilantro, chopped


1 tsp. gomasio (ground sesame with salt)
1 cup almond butter
½ cup cilantro, chopped
1 Tbsp. toasted sesame oil
1 Tbsp. minced fresh ginger
Juice of half a lemon
1 Tbsp. apple cider vinegar
1 Tbsp. seasoned rice vinegar
1 cup olive oil
1 Tbsp. white miso paste* (optional)


1. Mix the cabbage with the chopped onions and add cilantro.
2. Place all the dressing ingredients into a food processor and blend briefly. Mix into salad mix and serve.

This recipe makes 6 servings.
*Can be found in the Asian aisle at the grocery store, or at an Asian market.

Estrogen – The Good, the Bad and the Ugly

Estrogen is an essential hormone that has over 400 actions on a woman’s body. It’s what defines a woman. It’s been in your body since you were born and increases greatly at the time of puberty. It’s easy to take it for granted when everything is working automatically. When a young woman’s menstrual periods become irregular, painful or accompanied by severe mood swings, anxiety, depression or acne, that’s an indication of a system that’s gone awry. Birth control periods or Depo-Provera are a bad, ugly way to treat these problems. When prescribed, they do little to correct the underlying problem. These signs and symptoms are the way the body communicates to you that it needs help. A better approach is to determine the root cause that’s driving the problem. Continue reading Estrogen – The Good, the Bad and the Ugly

Does Estrogen Make You Gain Weight?

Does estrogen make you gain weightPostmenopausal women suffering from hot flashes, may hesitate to take estrogen because they’ve heard it can cause weight gain. Who needs any extra help to gain weight? Is there any truth to all this?

What are Bioidentical Hormones?

When you’re replacing deficient estrogen, it’s important to respect the wisdom of the body. No drug we give can approach the amazing complexity of the endocrine system. However, you can start by giving a hormone that is identical to the hormone that’s missing. We call these bioidentical hormones.

Another important factor is the route of administration. Estrogen is most commonly given as a pill that’s taken orally. It’s convenient and easy to pop a pill. But easy isn’t always the best. If we’re wanting to mimic the body, how does the ovary deliver estrogen to your tissues? I assure you the ovary doesn’t dump a big load of estrogen in your stomach once a day!! A more natural way to take estrogen is by applying it to the skin as a patch or cream. Estrogen taken in a pill form overloads your liver with excessive amounts of estrogen that increase harmful proteins, clotting factors and proinflammatory substances leading to various problems. Let me explain how oral estrogen leads to weight gain.

Weight Gain & Oral Estrogen

Weight gain from oral estrogen causes visceral obesity, the medical term for increased fat around your middle from fat that gets deposited in vital organs like the heart, kidneys and liver. This increased fat mass leads to increases in leptin produced by the fat cells. Topical, but not oral, estradiol prevents this increase in body fat and leptin. An interesting fact about visceral obesity is that women who take NO estrogen can also get weight gain around their middle because they develop insulin resistance. This is a frequent complaint from older women who are not on estrogen!

Oral, but not topical, estrogen increases the production of thyroxine-binding globulin (TBG) the carrier for thyroid hormone. Higher levels of TBG lower the amount of available thyroid hormone thereby lowering your metabolism. Oral, but not topical, estrogen also suppresses IGF-1, a marker for growth hormone. Growth hormone is needed to build muscle and burn fat. All this explains a common complaint I hear from women who’ve been on oral estrogen. “After starting oral estrogen, I gained 15 pounds in the first month and I didn’t increase my calories or lower my exercise. Now I’m eating less and exercising more and I just keep gaining!” Estrogen from injections or pellets can also lead to weight gain because the blood levels produced are much too high.

Weight gain from oral or injectable estrogen occurs because these preparations violate the natural physiology of the body. The ovary is amazing…it releases tiny bits of estradiol throughout the day directly into the blood stream. Even topical estradiol preparations can’t reproduce this same elegant effect, but it’s the closest delivery system we have. That’s why your chances of maintaining a healthy metabolism and weight are best when you choose topical estradiol preparations.

O’Sullivan, AJ, Crampton LJ, Freund, et al, “The route of estrogen replacement therapy confers divergent effects on substrate oxidation and body composition in postmenopausal women,” The Journal of Clinical Investigation, vol 102, (1998): pp 1035-1040.
Lwin R., Darnell B. Oster R, et al, Effect of oral estrogen on substrate utilization in postmenopausal women,” Fertility and Sterility, vol. 90, no 4, (2008): pp 1275-1278
DeCarlo C, Tommaselli G, et al, “Serum leptin levels and body composition in postmenopausal women: effects of hormone therapy,” Menopause, vol 11, no 4 (2004): pp 466-473
Nachtigall LE, Raju U, Banerjee S, et al, “Serum estradiol binding profiles in postmenopausal women undergoing three common estrogen replacement therapies: association with sex hormone binding globulin, estradiol and estrone levels,” Menopause, vol 7, (2000): pp 243-250.
Slater CC, Hodis HN, Mack WJ, et al, “Markedly elevated levels of estrone sulfate after long-term oral, but not transdermal, administration of estradiol in postmenopausal women,” Menopause, vol 8, (2001): pp 200-203

Safer Options Exist—Top Eight Natural Birth Control Methods

Safer Options Exist—Top Eight Natural Birth Control Methods







Young women are often not given options for natural birth control. They opt for BCPs because they’re easily available and convenient and they’re not aware of the the health risks.Here are some effective options for natural family planning that prevent pregnancy without damaging your health.

Barrier Methods:

Male condoms: Condoms have a 98 percent effectiveness rate when used correctly. A water-based lubricant will increase the effectiveness; do not use an oil-based lubricant, however, as they break the latex.
• Female condoms: These thin, soft polyurethane pouches fitted inside the vagina before sex are 95 percent effective. Female condoms are less likely to tear than male condoms.
Diaphragm: A diaphragm is a soft latex or silicone dome that’s inserted into the vagina before sex. It must be initially fitted by a doctor. When used correctly with spermicidal jellies, it’s 92 to 98 percent effective.
Cervical cap: This heavy rubber cap fits tightly against the cervix and can be left in place for 48 hours. Like the diaphragm, a doctor must fit the cap. Proper fitting enhances the effectiveness above 91 percent.
• Cervical sponges: The sponge, made of polyurethane foam, is moistened with water and inserted into the vagina prior to sex. It works as a barrier between sperm and the cervix, both trapping and absorbing sperm and releasing a spermicide to kill them. It can be left in for up to 24 hours at a time. When used correctly, the sponge is about 89-91 percent effective.

Tracking Ovulation:

• Calendar Method:
The woman avoids sex during the week the she is ovulating. This technique works best when a woman’s menstrual cycle is very regular. However, it may not work very well for couples who use it as the sole means of contraception, as its success rate is only around 75 percent. You can boost its effectiveness by combining it with the temperature and mucus methods described below.
• The Basal Body Temperature Method: This is a way to pinpoint the day of ovulation so that sex can be avoided for a few days before and after. It involves taking your basal body temperature (your temperature upon first waking) each morning with an accurate “basal” thermometer, and noting the rise in temperature that occurs after ovulation. This method works best in women who have regular monthly cycles.

Following your basal body temperatures enables you to become so aware of ovulation that when you’re ready to have your family you can better plan your pregnancy. I used this method myself when
I was in medical school and I was able to later choose a convenient time to have my pregnancy!

Be aware that illness or lack of sleep can change your body temperature and make this method unreliable by itself, but when it is combined with the mucus method, it can be an accurate way of assessing fertility. The two methods combined can have a success rate as high as 98 percent.

The Mucus Method: This involves tracking changes in the amount and texture of vaginal discharge, that reflect rising levels of estrogen in your body. For the first few days after your period, there is often no discharge, but there will be a cloudy, tacky mucus as estrogen starts to rise. When the discharge starts to increase in volume and becomes clear and stringy, ovulation is near. A return to the tacky, cloudy mucus or no discharge means that ovulation has passed.

I realize the convenience of birth control pills is what makes them so popular. However, my advice to women is to seriously evaluate the risks versus benefits before taking any type of birth control pills. A bit of planning on your part is well worth the health risks you’ll avoid.

Recommended Reading

1. Outliving Your Ovaries by Dr. Marina Johnson. While I initially wrote this book for menopausal women, I also included chapters for young women that included a section on natural birth control.
2. Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control, Pregnancy Achievement and Reproductive Health by Toni Weschler
3. Honoring Our Cycles: A Natural Family Planning Workbook by Katie Singer

Are Birth Control Pills Safe?


Are Birth Control Pills Safe?Artificially controlling your menstrual cycle with birth control pills (BCPs) may seem like an ideal method for highly effective, relatively inexpensive and easily reversible birth control. After all, they come in these cute, little pink packs and they’re given to 13 year-girls, so they must be safe, right? Think again. You need to know that BCPs have been linked to numerous, serious health risks, so it’s important to carefully weigh the benefit of this convenience against its considerable risks.

Artificially Manipulating Your Hormones is a Risky Proposition

The pituitary gland, a small pea-sized gland at the base of brain, is in charge of regulating all hormone production in your body. Most birth control pills, patches, vaginal rings, and implants contain a combination of synthetic derivatives of the hormones, estrogen and progesterone. Young women are astonished to learn that the dosage of these synthetic drugs in BCPs is ten times higher than is seen with natural hormones given to menopausal women! Understand that your reproductive system does not exist in a bubble. All the different hormones and organ systems “talk” to each other. When your pituitary sees these high hormones, it perceives that your body is in an “overdose” situation. Therefore, the logical response from the pituitary is to send a signal to the ovary to stop ovulation, the primary source of estrogen production! If there’s no ovulation, you can’t get pregnant, which is the whole goal of BCPs.

It would be fine if the only role of estrogen was for reproduction. However, you need to know that estrogen has over 400 actions on different tissues in your body! Women on BCPs often have NO detectable levels of natural estrogen in their body! These low levels of natural estrogen can have variable results. Some women seem unaffected…others develop headaches, sexual dysfunction or gain weight around their waistline. Young women may hesitant to question their doctors or may not realize these are BCP side effects. Read on to educate yourself on the risks of BCPs.

Well-Documented Risks of Synthetic Estrogen and Progestin

Because hormonal BCPs contain synthetic estrogen and progesterone,
they have the same well-documented risks, including an increased risk of blood clots, stroke, heart attack, and breast cancer. With HRT, these risks are primarily seen with oral estrogen pills especially when combined with a synthetic progestin. It’s important to emphasize that these risks increase with higher doses and with longer duration of use. Recall, the doses used in BCPs can be ten times higher than those in HRT! If BCPs are used for one to two years before starting a family, risk is probably minimal. However, many young women start BCPs as young as twelve or thirteen and may take them for twenty years or longer!

For the convenience of contraception (which you can do naturally just as well, and I’ll explain how below), you are putting yourself at risk for the following:

Cancer: Women who take birth control pills increase their risk of cervical and breast cancer, and possibly liver cancer as well.

Fatal blood clots: All birth control pills increase your risk of blood clots and subsequent stroke. And if your prescription contains the synthetic hormone desogestrel, your risk of fatal blood clots nearly doubles!

Thinner bones: Women who take birth control pills have lower bone mineral density (BMD) than women who have never used oral contraceptives.

Heart disease: Long-term use of birth control pills may increase plaque artery buildup in your body increase plaque artery buildup that may raise your risk of heart disease.

Impaired muscle gains: A recent study found that oral contraceptive use can impair muscle gain from resistance exercise training in women.

Decreased cognition and memory

Long-term sexual dysfunction: BCPs may interfere with a protein that keeps testosterone unavailable, leading to long-term sexual dysfunction including decreased desire and arousal.

Migraine headaches

Weight gain and mood changes

Yeast overgrowth and infection

Newer Hormonal Birth Control Methods May Be Even Riskier

Two of the newer hormonal contraceptives—the hormone-releasing vaginal ring, NuvaRing, and the combination pills Yaz and Yasmin, that also contain the hormone drospirenone in addition to estrogen and progestin—may be of even greater concern than the older “classics.”

The NuvaRing is a flexible vaginal ring that is replaced once a month. It releases estradiol and desogestrel. The latter is known as a “third generation” progestin, desogestrel, which has been linked to serious health concerns and may double your risk of blood clots when compared to second generation contraceptives. The NuvaRing delivers a relatively high dose of this hormone.

Other types of birth control also contain this third generation hormone, including some implants. More than 4,000 lawsuits have been filed against Bayer for serious side effects suffered by women taking the newer birth control pills Yaz and Yasmine. The four most common adverse effects are blood clots, gallbladder disease, heart attack and stroke. The first trial is scheduled to begin in September, and according to some legal estimates, the number of lawsuits filed may at that point reach 30,000.

So faced with these dire risks, what’s a woman to do for contraction? See my next blog entry that gives you guidance on natural options for birth control.

Perimenopause – Making It a Smoother Transition


Perimenopause, the time around menopause, can last a few months to several years. It can begin as early as the late thirties but typically starts in the forties. An occasional woman will have normal cycles with no symptoms until her last menstrual period in her fifties but that’s the exception rather than the rule. For many women, it’s a rocky road, where they feel they’ve lost control over their bodies!

What changes are associated with perimenopause?

Women will notice that their menstrual cycles shorten from 28 days to 20-24 days. At the same time, the menstrual flow usually gets heavier and/or longer. Instead of the typical four or five-day period, it becomes seven to ten days! The period may worsen so that she’s bleeding three weeks out of each month! The bleeding can be profuse and associated with huge clots and some women are homebound on those days.

Excessive bleeding at this time is the most common cause for the 600,000 hysterectomies that are done each year! If women educate themselves about this problem, they will be able to seek medical help and prevent the need for such hysterectomies!

A woman may have never had premenstrual syndrome (PMS) but she suddenly finds she’s experiencing PMS symptoms like irritability, mood swings or migraine headaches in the time preceding their period. Weight gain especially around the midline, is another bothersome symptom! Women complain they’re eating the same as before but they’re gaining weight for no apparent reason. Or diets that previously worked for them have no results!

Other perimenopausal symptoms include insomnia, hot flashes, palpitations, dizzy spells, constipation and fluid retention. The symptoms are similar to menopause but they are milder and often intermittent. This intermittent aspect can present a challenging problem because if the woman is given hormone replacement (HRT) for bad symptoms when her body’s production of estrogen is low, HRT can later cause weight gain and other symptoms when her own estrogen “comes back!”

Each and every woman will go through perimenopause at some time in her life. Educating yourself now and working with an experienced physician who also recognizes these changes will greatly facilitate this time in your life.

Testosterone Increases Heart Attacks: Fact or Fiction

Testosterone Increases Heart Attacks: Fact or Fiction

Headlines screamed in 2013 after a study in the Journal of the American Medical Association (JAMA) reported increased cardiovascular risk in men given testosterone replacement. The study compared the incidence of heart disease in 8709 low testosterone men in the Veterans Administration health system who underwent coronary angiography. Their data showed that the testosterone-treated group had a 25.7% absolute rate of stroke, heart attack and death compared to 19.9% in the untreated group. These findings received enormous media attention and were repeated in a widely quoted accompanying editorial.
However, it was later found that the statistical analysis was incorrect and instead the number of adverse evens was lower by one-half in the testosterone-treated group! In March 2014, JAMA published a second correction of additional data errors involving more than 1000 individuals. Furthermore, it was revealed that the “all-male” study population actually comprised nearly 10% women. To date, 29 medical societies have called for the retraction of the original article, arguing that the data are not credible.

In clinical practice, when giving testosterone to men with deficient levels, we routinely see improvement in sex drive, sexual function, muscle mass, bone density and reduced fat mass.

With regard to the cardiovascular system, a review article of several dozen studies, revealed:
Untreated low testosterone is associated with increased mortality, generalized hardening of the arteries and heart disease;
Mortality is reduced by one half in testosterone deficient-men treated with testosterone therapy compared with untreated men;
Exercise capacity is increased with testosterone treatment compared to placebo in men with know heart disease.
Testosterone replacement compared to placebo results in uniform improvement in cardiovascular risk factors (fat mass, waist circumference, insulin resistance).

The media tends to sensationalize the news. When you read headlines warning about risks from a hormone, you need to pause and use some common sense. Does it really make sense that a hormone that’s part of your body’s design suddenly becomes dangerous when you give it to someone who’s deficient? Each hormone plays a vital role in your body. The whole specialty of endocrinology is devoted to evaluating and treating diseases caused by hormones that are deficient or in excess.

As a board-certified endocrinologist who’s been in practice for over 25 years, I’ve learned to have a healthy respect for the body’s ability to self-heal. When I see men with low testosterone, before rushing in with testosterone replacement, I first want to determine WHY
a man is deficient in testosterone. Does he have a treatable underlying condition that’s interfering with his body’s ability to produce testosterone? For example, testosterone is primarily produced during sleep. Does he have a correctable condition like sleep apnea that’s causing his low testosterone state? If I can get his body to restore its own testosterone production, that’s better than anything I can prescribe! If testosterone levels are deficient and testosterone replacement is needed, it’s important to avoid excessive levels because those can lead to adverse events. Hormones are powerful therapies and it’s always best to respect the wisdom of the body.
Vigen R, O’Donnell CI, Barón AE, et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA. 2013;310;1829-1836

Cappola AR. Testosterone therapy and risk of cardiovascular disease in men. JAMA. 2013;310:1805-1806.

Correction. Incorrect number of excluded patients reported in the text and figure. JAMA. 2014;311:967.

Traish AM, Guay AT, Morgentaler A. Death by testosterone? We think not! J Sex Med. 2014;11:624-629.

Morgentaler A, Lunenfeld B. Testosterone and cardiovascular risk: world’s experts take unprecedented action to correct misinformation. Aging Male. 2014;17:63-65

Morgentaler A, Miner MM, Caliber M, Guay AT, Khera M, Traish AM. Testosterone therapy and cardiovascular risk: advances and controversies. Mayo Clin Proc. 2015;90:224-251.

Corona G, Isidori AM, Buvat J, et al. Testosterone supplementation and sexual function: a meta-analysis study. J Sex Med. 2014;11:1577-1592

Isidori AM, Giannetta E, Greco EA, et al. Effects of testosterone on body composition, bone metabolism and serum lipid profile in middle-aged men: a meta-analysis. Clin Endocrinol (Oxf). 2005;63:280-293.

Tracz MJ, Sideras K, Boloña ER, et al. Testosterone use in men and its effects on bone health. A systematic review and meta-analysis of randomized placebo-controlled trials. J Clin Endocrinol Metab 2006;91:2011-2016

Chronic Insomnia and Hormones

Chronic Insomnia and Hormones

Bonnie had always been able to enjoy a good nights sleep in the past. No matter how stressed she might be, she could count on laying her head on her pillow, falling asleep and waking up the next morning refreshed and rejuvenated. However, when she reached her mid 40’s, her periods started changing and she began experiencing sleep problems. First, she would just have insomnia the night before starting her period. As her periods became more irregular, she started waking up in the middle of the night around 2 or 3 am and would find herself wide awake and unable to go back to sleep. With so little sleep, she would be exhausted the next morning. 

Over-the-counter sleep aids would make her feel sluggish the following day. By the afternoon and early evening, she would be crashing. She came to see me on maximal doses of prescription sleep medicine and still was sleeping poorly.

Bonnie suffered from a very common sleep disorder that occurs at the time of perimenopause or menopause. It’s caused by declining levels of estrogen and/or progesterone. It is characterized by wakefulness in the middle of the night and can be very debilitating when it continues long-term. The typical patient with this type of insomnia often becomes addicted to prescription sleeping pills. Bonnie’s insomnia totally resolved after her estrogen and progesterone levels were normalized.

While menopause occurs in all women, insomnia does not uniformly affect all women and
therefore, women may not recognize that this is a low estrogen symptom. Furthermore, if the
insomnia has gone on for many years, other secondary conditions such as depression, anxiety,
chronic fatigue, fibromyalgia, sleep apnea and obesity may also develop.
 Patients are often
prescribed prescription medications such as antidepressants, Xanax, and Adderal for these
conditions! Antidepressants can lead to weight gain and Xanax and Adderal are addictive!
Doesn’t it make more sense to correct the underlying hormone imbalance that’s causing these

It’s important to emphasize that insomnia can result from endocrine problems in both men and
women. Disorders of thyroid hormone, testosterone, cortisol, and growth hormone can all
cause sleep disorders. Detecting a subtle endocrine imbalance may sometimes be difficult
requiring the expertise of an endocrinologist.
Sleep is a mysterious bodily process that is
absolutely essential to good health. We should not have to rely on a drug to make us sleep! We
do not have to be “taught” how to sleep. Every member of the animal kingdom has an
obligatory need for sleep. If humans go much more than 18 hours without sleep, they start
experiencing “microsleep” where they “zone out” from a few seconds to minutes. In fact, many
accidents occur when people are sleep-deprived – such as the infamous Exxon Valdez disaster
and the Chernobyl nuclear accident. Falling asleep while driving is responsible for at least
100,000 crashes, 40,000 injuries, and 1550 deaths per year.
People can also develop insomnia
from poor lifestyle choices. Overzealous Americans intent on squeezing more work, more fun,
more family time and more sheer activity into their lives often short-change their sleep.

What are ways to promote a good night’s sleep?

Try going to bed at the same time each night
and getting up at the same time. The body likes a regular schedule. Sleep in a cool, dark room –
use nightshades, white noise or a sleep mask if necessary. Avoid spicy food or caffeine-
containing foods in the evening. Finish eating at least 3 hours before bedtime. Many individuals
find that heavy intake of sugar or alcohol at dinner leads to restless sleep. Start winding down in
the evening. Do not engage in heavy exercise late at night. Don’t watch the 10 o’clock news or
read grisly books which cause mental over-stimulation. Individuals who can’t function without a
large dose of coffee in the morning are usually sleep-deprived.

Just how much sleep is enough sleep?

Individuals who consistently get less than seven or eight
hours of sleep per night are often sleep-deprived. Interestingly, people who need MORE than
eight hours of sleep may also have a sleep disorder. They need more than eight hours of sleep
because the sleep they are getting is poor quality sleep. People do not have less need for sleep
with aging. It’s just that sleep disorders are so common in older people that many think this is
“normal.” Most sleeping pills “knock you out” but do not promote normal sleep architecture.

If you are experiencing persistent insomnia, consider seeing an endocrinologist, a physician who
specializes in hormone disorders. Establishing hormone balance can lead to normal, refreshing
sleep which is the body’s own way of healing a myriad of health problems.

Sugar-Free, Chocolate Macaroon Truffles

Sugar-Free, Chocolate Macaroon Truffles


1 cup Raw, organic, cocoa powder*

1 cup Raw, organic, cocoa butter*

3⁄4 cup Full-fat coconut milk (Native ForestR has BPA-free can) 2/3 cup Raw, organic Yacon syrup**

2 tsp Lo Han sweetener***

1 tbsp Organic vanilla extract

1⁄2 tsp Kosher salt, to taste

1 cup Unsweetened, organic shredded coconut (Let’s Do OrganicR)

2 cups Raw, organic, sprouted walnuts, finely-chopped*

* Can be purchased at ** Can be purchased at

***Can be purchased at purelo-lo-han-sweetener-monk-fruit-2-8-oz-80-grams-pwdr

Makes: 42 small truffles

1. Add water to a Dutch oven pot and bring to boil on stove top. Measure out cocoa butter into a large 4-cup Pyrex measuring cup. Place Pyrex cup into boiling water and turn down heat to low-medium. Cocoa butter will melt in about 10 minutes. After fully melted, mix in cocoa powder, Lo Han and then add coconut milk. Stir in the vanilla, salt and Yacon syrup. Blend well to dissolve any clumps. Add in the shredded coconut.

2. Scoop mixture into a bowl and place in the freezer for 30 minutes. Stir with a spoon to break up the hardened spots and place in the refrigerator for 45 minutes to firm up further.

3. Form one-inch balls with your fingers and shape them in your palms. After making 10-12 balls, your hands will become very sticky with the mixture and you’ll need to wash your hands. This is the best time to roll each ball in the finely- chopped walnuts for a nutty coating.

4. Store in refrigerator in a covered glass dish until ready to enjoy!