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- BREAKING THE STIGMA ON HORMONE REPLACEMENT THERAPY
Menopause can be a challenging transition, impacting not only a women’s quality of life, but her relationships, health goals, and career. Not to mention the day-to-day symptoms of hot flashes, night sweats, insomnia and anxiety can be debilitating with few options for relief. Herbal therapies and nutraceuticals can certainly help lessen the severity of these symptoms, but for many women, they’re also taking into consideration the long-term impacts of the loss of estrogen on their cardiovascular health, bone health, and most importantly, brain health. Many women and clinicians alike are familiar with the option of hormone replacement therapy (HRT) - in more updated terminology 'menopause hormone therapy' (MHT) - through and after menopause, but many don’t take advantage of their use due to decades-old research from the Women’s Health Initiative in 2002 stopping their study due to researchers finding that the combination of estrogen and progestin had an increased risk of breast cancer, heart attacks, stroke, and blood clots (1). Data shows the use of HRT following this study dropped by approximately 80% (2). However, since then, numerous meta-analyses and long-term observational data have helped paint a more well-rounded realm of research to inform clinical care guidelines surrounding HRT. Now, we just have to work to raise educated awareness and break the stigmas. A Summary of the Latest Hormone Replacement Therapy Data: The 2002 WHI study flaws/misinterpretations were that primarily older women were at high risk from the use of hormones. The benefits of hormone therapy generally outweigh the risks for healthy women who are under 60 years old and were initiated within ten years from the onset of menopause. In an 18-year follow-up study among ~28,000 post-menopausal women, all-cause mortality (aka death in general) and cause-specific mortality (aka death from cardiovascular disease, cancer, and other significant causes) was seen to be no different between the intervention group and the placebo group when HRT was used for a median of 5.6-7.2 years (3). In the same study, the authors conclude that when HRT use is introduced early in menopause, women generally live longer than those who didn't take hormones. Furthermore, according to pooled stats of over 30 RCTs, women who started HRT before age 60 had a 39% lower risk of death than those who didn't take hormones. Although total cancer mortality did not differ significantly between intervention and placebo groups, significant increases in breast cancer were seen in the treatment group using oral estrogen plus progestins (3,4). Findings for breast cancer point to an adverse effect from progestin (artificial progesterone) on the breast epithelium (3), but are linked to favourable effects on decreasing endometrial cancer with long-term use. Important things to consider: these studies only evaluate one dosage, one formulation of a hormone, and one route of administration (aka not transdermal estrogen and bioidentical progesterone) thus, results are not necessarily generalizable to all patients and hormone preparations. The loss of estrogen through menopause has been linked to an increased risk of dementia and Alzheimer’s, explaining why women are at higher risk than men of developing it later in life (5). Brain imaging studies show a lower metabolic state in the brain has been observed through the menopause transition in women, likely relating to increased brain amyloid-beta deposition as compared to premenopausal women and age-matched men (6). Estrogen replacement therapy for young women transitioning through menopause (under 60 and within 5 years of menopause) is a promising option for preventing this hypometabolic brain state and reducing the risk of Alzheimer's (especially in those genetically predisposed). However, for women older than 60 or 5+ years after menopause, or for those presenting with signs of dementia already, HRT may actually increase the risks. Each cause should be looked at individually. This leads to our next question… What about Bioidentical Hormones Increased breast cancer risks were seen in groups using oral hormones, with synthetic progestins. Since these studies, newer formations of hormones that were not widely used at the time of these studies, such as transdermal estrogen and micronized progesterone. Transdermal estrogen shows superior benefits since it is applied across the skin and therefore surpasses the liver, minimizing negative impacts on liver function and the risk of blood clots and strokes. Furthermore, the most available literature so shows that when transdermal estrogen is used in combination with oral micronized progesterone, no increased risk of breast cancer has been observed thus far. Where else is HRT beneficial? Outside of menopause (loss of menses > 1 year) and perimenopause (a loss of or delay in menses > 7 days after age 45), premature ovarian insufficiency (POI) occurs when the loss of ovarian function and associated hormones declines prior to age 40. These women experienced extended periods of their lifespan without the protective impacts of estrogen and progesterone, and as such are at significantly greater risk of bone loss & osteoporosis, cognitive disorders, and premature mortality (largely associated with cardiovascular disease). This group of women is often offered an oral contraceptive as a management tool, however, synthetic hormones do not equate to the same health benefits as physiological replacement of deficient hormones, and as such do not provide the same protection as HRT. If you've been given 'the pill' to manage your premature ovarian insufficiency, I highly encourage you to revisit your options. Contraindications to consider While numerous health benefits may be seen for those interested in using MRT/HRT to manage menopause, personal medical history must always be considered. The risks will likely outweigh the benefits in groups of women who have a personal history of breast, endometrial, as well as any hormone-receptive-positive cancer, including those with known BRCA or HER genetic family history. This is why all use of hormone replacement must be considered on a case-by-case basis, with informed consent so you know your risks. In conclusion, women are more likely to suffer from hormone-related challenges through menopause (with many reporting negative impacts on their sleep, work performance, and relationships, and each case must be looked at individually) than be given the option of considering hormone replacement to manage their symptoms or lower their risks. If you suspect you may be showing early signs of perimenopause, if you’re in the midst of menopause symptoms, or if you wish to discuss the use of BHRT, schedule your initial consult with Dr. Courtney Holmberg, ND at 647 351 7282 or online here today. References: Manson JE et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials. JAMA. 2013 Oct 2;310(13):1353-68. Manson JE, Kaunitz AM. Menopause Management--Getting Clinical Care Back on Track. N Engl J Med. 2016 Mar 3;374(9):803-6. Manson JE, Aragaki AK, Rossouw JE, et al. Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality: The Women’s Health Initiative Randomized Trials. JAMA. 2017;318(10):927–938. Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women’s Health Initiative randomized trials. JAMA. 2013;310(13):1353-1368. https://www.alzheimers.org.uk/about-dementia/risk-factors-and-prevention/hormones-and-dementia#:~:text=Oestrogen's%20protective%20effects,of%20the%20amyloid%2D%CE%B2%20protein. Scheyer O, Rahman A, Hristov H, Berkowitz C, Isaacson RS, Diaz Brinton R, Mosconi L. Female Sex and Alzheimer's Risk: The Menopause Connection. J Prev Alzheimers Dis. 2018;5(4):225-230. doi: 10.14283/jpad.2018.34.
- EXPLORING THE MICROBIOME-GUT-BRAIN CONNECTION
One of the most important focuses in life is prioritizing our mental health. Whether you prefer self-care practices, meditation, yoga, or even beauty routines, it is beneficial to engage in something that slows us down and focuses us inwards. But believe it or not, outside of exercise and meditation, one of the best ways to support your mental health is to adopt habits that support your gut health. But what is the connection between gut bacteria and mental health? Our gut is the home of our enteric nervous system, often referred to as our "second brain”, and evidence shows the microbiota in our gut can produce neurotransmitters that can largely influence this nervous system. Beneficial bacteria in our gut have the capability of influencing our mood, encouraging vitamin production, regulating a healthy sleep rhythm, and benefiting hormone production. The synergy between the Gut-Brain via our microbiome has significant implications for supporting mental health and overall well-being. Our Microbiome's Impact on Our Mental Health To understand the microbiome's impact on our mood, we must first understand the gut-brain axis. The gut-brain axis (GBA) consists of bidirectional communication between the central (aka ‘fight or flight’) nervous system and the enteric (a large division of the ‘rest and digest’) nervous system, linking emotional and cognitive centers of the brain with peripheral intestinal functions like blood flow, transportation and immune function. The gut-brain axis's primary mechanism is to regulate: - production, expression and turnover of neurotransmitters (serotonin, GABA etc) - protection of the intestinal barrier - modulation of enteric sensory afferents (digestion, absorption, elimination) - making short-chain fats that influence memory, mood, learning, and inflammation - immune regulation Communication between these two systems involves the release and binding of neurotransmitters, most notable being GABA, dopamine and serotonin (1). Not only do they influence the way we feel, but they also influence the peripheral intestinal functions we just mentioned. Another interesting fact - during fetal development, the gut and brain tissue come from the same cells in the embryo, which splits to create two separate organs connected by the vagus nerve. In 2012, the Human Microbiome Project Consortium was published, creating a framework for the structure, function, and diversity of the healthy human microbiome. From there, research progressed to show that our gut microbiomes can have an impactful influence on our mood, and vice versa. Numerous studies associate gut health and Parkinson's disease, anxiety, and depression. For example, people with low diversity in the gut are more likely to experience anxiety and depression. Data suggests as our diet influences our microbiome, our microbiome influences the activity of our vagus nerve, which is directly correlated to our capacity to regulate stress responses (2). This is the same mechanism that breathing, yoga, and meditation contribute to stress resilience and mitigating mood and anxiety symptoms. How to Support Your Microbiome for Mental Health Essentially, consuming the right foods and probiotics can improve mental health and well-being. Let's break down some of the most impactful changes you can make. Remove inflammatory foods Eliminating pro-inflammatory foods like sugar, gluten-containing grains, and dairy might be a great place to start if you’re experiencing mental health struggles. These foods have been linked to increased levels of systemic inflammation and the resultant decline in our beneficial flora (3). Instead, incorporate more fresh fruits and vegetables, fibres, and anti-inflammatory spices that can affect your microbiome food sources and support. For example, some of the best gut-boosting spices that promote inflammation reduction are saffron, turmeric, bay leaves, ginger and cinnamon. Incorporate fermented foods and probiotics Research suggests that specific probiotic strains have the capability of influencing our mood, gut function, and inflammation levels. Of particular interest are the strains Lactobacillus helveticus R0052 and Lactobacillus rhamnosus R0011, with studies demonstrating better stress levels and coping skills which may be a result of benefits on barrier function and suppressing inflammation (4). Eating more fermented foods like yogurt, kimchi, sauerkraut and kombucha (watch for added sugar) can significantly increase your exposure to probiotics. Eat More Fibre Eating nuts, seeds, and leafy greens is vital as they are rich in fibre, folate, iron, and other vitamins. Leafy greens like swiss chard, spinach, arugula, and collard greens are excellent sources of folate. Folate is an essential vitamin, helping to decrease depressive symptoms, and nuts, seeds and greens rich in soluble fibre improve gut bacteria by acting as a source of nutrition. Good bacteria eat these fibres to produce short-chain fatty acids (most notable being butyrate), which have been shown to regulate nutrient absorption, reduce inflammation and oxidative stress on the gut lining, reinforce gut barriers, and improve motility. Furthermore, an increasing number of studies have stressed the role of butyrate in the prevention and inhibition of colorectal cancer. Beyond the gut, butyrate is also showing promising potential for its therapeutic benefits in hemoglobinopathies, genetic metabolic diseases, and metabolic diseases (insulin resistance, high cholesterol, and ischemic stroke). Support Your Vagus Nerve The vagus nerve is comprised of a group of afferent fibres that originate in numerous layers of the intestinal walls, and connect to an area in the brain that regulates hunger, appetite, and the digestive process via gut hormones and regulatory peptides like ghrelin, cholecystokinin (CCK), glucagon-like peptide-1 (GLP-1), and peptide YY (PYY). What's even more interesting is there seems to be a symbiotic relationship between your microbiome and these gut hormones, which ultimately bind to chemoreceptors and regulation our food intake and energy balance. Strengthening your Vagus nerve may include things like cold plunges, breathwork, humming/singing, morning sunlight, and certain forms of meditation. A really practical way to actively support your Vagus nerve would be to check out the Nerva App (a personal fav) Focus on Vitamin D While not entirely correlated to gut function, it's always important to highly that not receiving enough vitamin D can lead to significant increases in anxiety and depression. Unfortunately, vitamin D deficiency is common, so it is essential to implement more foods rich in this vitamin. Herring, salmon, cod liver oil, sardines, and egg yolks are some of the best vitamin D-rich foods, but it’s important to supplement during winter months to ensure you're getting enough. Naturopathic Support for Your Gut-Brain Axis If you want to take a different approach regarding your mental health, start by considering how your gut influences your feelings. Naturopathic support aims are removing the aggravators, improving the gut barrier, and restoring the microbiome to get you back to feeling like the person you were meant to be. Dr. Courtney Holmberg has a clinical focus on digestive health, the microbiome, and its influence on mental health. Contact us at 647-351-7282 or visit us online to book an appointment. References: https://pubmed.ncbi.nlm.nih.gov/25830558/ https://pubmed.ncbi.nlm.nih.gov/29593576/ https://pubmed.ncbi.nlm.nih.gov/25415497/ https://www.wageningenacademic.com/doi/abs/10.3920/BM2011.0032 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070119/
- THE BEST SOURCES OF IRON-RICH FOODS TO INCORPORATE INTO YOUR DIET
Iron is a crucial part of our daily diet and probably the most common deficiency among menstruating females. Fortunately, there are plenty of iron-rich foods that you can incorporate into your diet to improve your nutritional health, iron intake, and energy levels. This article will cover what foods are high in iron and why getting iron from food is so important. Why Iron Is a Vital Part of Your Diet? Iron plays a critical role in a variety of bodily functions. Most importantly, iron makes up hemoglobin, a transport molecule that red blood cells use to deliver oxygen to the tissue throughout your body. Oxygen is one of the most important cellular respiration and energy production factors. Your body also needs iron, like the active thyroid hormone, to make important hormones. As one might imagine, an iron deficiency can lead to several adverse health ramifications. An iron deficiency may result in several potentially severe symptoms that can negatively affect your daily life. Anemia is the most common condition associated with iron deficiency and is impactful. Here are a few of the symptoms those with anemia may experience: Fatigue Shortness of breath Dizziness Headaches Chest pain The best way to avoid anemia is by getting the right amount of iron with an iron-rich diet. Heme vs Non-Heme Sources You’ll hear a lot about iron ‘bioavailability’, meaning how readily available or absorbable the iron is in the food that you’re consuming. Heme iron comes solely from animal-based sources, such as meat, poultry and seafood. Heme iron tends to be more easily absorbed than non-heme plant-based sources. The National Institutes for Health (NIH) suggested that a solely plant based diet requires double the daily iron intake compared to those eating meat (1). The guidelines from the NIH for daily iron intake are as follows (1): Nonpregnant Women ages 19 to 50 18 milligrams (mg) Pregnant Women 27 mg For women Age 51 and Older, 8 mg For men Age 19 and Older, 8 mg Infants and Children 7 to 16 mg, depending on age Sources of Iron-Rich Foods If you want to enhance your diet with iron, you’ll be happy to know that many iron-rich foods are affordable and delicious. While not high in iron, some foods, like citrus fruits, will help you absorb more iron from your meals since vitamin C aids irons transport across the gut. Here are some foods that can boost your body’s iron levels. Oysters, mussels and Clams If you love to splurge on fresh seafood, you’ll be happy to know that the price tag has great nutritional benefits. According to the USDA, six medium oysters come with a whopping 6.1 mg of elemental iron, a 3rd of a woman’s daily intake. Shrimp and crab are great, too, providing between 2-3 mg per 3 oz serving. Important to note this would not be advisable for pregnant women due to the increased risks of infection from raw foods. Dark Leafy Greens Dark leafy greens are always a go-to plan based sources of iron. 100g of boiled spinach provides 1.6mg of non-heme iron, whereas broccoli provides approximately 1mg per 100g serving. Broccoli is also high in vitamin C, which can help the body to absorb the non-heme iron it contains. Red Meat Red meat, pork chops, and especially organ meats like liver and giblets make for a fantastic source of iron. Red meat serves up around 3-4 mg per 100g depending on the source, whereas organ meats are closer to 6 mg per 100g serving (although not everyones cup of tea). These sources are also high in saturated fat and can raise cholesterol levels, so they should be eaten in rotation and as part of a balanced diet. Dark Chocolate If you need more iron in your diet, dark chocolate is a good source of iron. Dark chocolate has 8 mg per 100 g serving!!! You’re welcome. Eggs Along with fortified cereals and oats, eggs make a great way to kickstart your iron intake in the morning, giving you about 1 mg per serving. Legumes Legumes and other kinds of beans, like black beans and kidney beans, are reliable sources of iron. While they're all non-heme sources, they contain up to 2 mg per 100g serving. Let's not forget about tofu, which lends up to 5.4 mg per 100g! Eating a Balanced, Iron-Rich Diet Fortunately, there are many iron-rich foods that you can easily incorporate into your diet. While taking other nutritional needs into account, the best source of iron for you can be something you love to eat regularly. Nutrition is essential to everybody aspect, so you’ll want to ensure you get what you need. To learn more about testing your iron and determining possible correlations to your symptoms, contact Dr. Courtney Holmberg, Naturopathic Doctor in Toronto, at (647) 351-7282 today to book a consultation. References: https://ods.od.nih.gov/factsheets/Iron-Consumer/ https://fdc.nal.usda.gov/index.html
- NATURAL TIPS FOR GLOWING SKIN
Let's face it, our face is our resume, and glowing skin is something we're all after. Breakouts, congestion and a dull complexion can be common, and at times frustrating, especially when we're doing 'all the right things'. While there is no cookie-cutter solution to healthy skin, there are certainly a few simple lifestyle changes and adjustments to your daily routine you can make to reduce the appearance of blackheads, whiteheads, and other types of acne. Follow these tips to help jumpstart your journey to clear skin. Cleanse Once A Day Cleansing is an essential part of any skincare routine. It helps remove dirt, oil, makeup, dead skin cells, and other impurities that clog your pores and hair follicles. However, overwashing can also compromise your skin's microbiome & barrier, resulting in dehydration and an overcompensation of oil production that causes acne. Start your day with lukewarm water to rinse (but not ‘wash’ your face), and finish the day with a gentle cleanser. For acne-prone skin, use non-foaming options, and choose products that are in line with your skin's natural pH of ~ 6. Make sure you don't scrub too hard or over-wash, as this can make acne worse and leave your skin more prone to irritation. Moisturize Your Skin One of the most important steps to glowing skin is moisturizing. Dry skin often leads to increased oil production and acne breakouts, so it's crucial to keep your skin hydrated. When choosing a moisturizer, my general motto is ‘less is more’. Choose limited-ingredient products that contain high-hydration ingredients, like hyaluronic acid. If your skin is acne prone, avoid pore-clogging ingredients like oils and parabens. If you have oily skin, this doesn't mean you should skip moisturizing. Choose an oil-free formula to control excess sebum production while providing much-needed hydration. Drink Water! It sounds so straightforward, but most people's dry skin, wrinkles and under-eye bags are being emphasized by dehydration. No amount of $$ fancy creams can replace internal hydration, so drink up. You should aim for approximately your kg. body weight in oz. of water per day (ie 60 kg = 60 oz water minimum). Choose Non-Comedogenic Products Comedogenicity means how likely a product is to clog your pores. Non-comedogenic skincare products are designed to keep pores clear. This is especially important for people with acne-prone skin, as blocked pores can lead to irritation. Look for products with the "non-comedogenic" label when shopping for skincare and makeup items, such as aloe vera, vitamin C, hyaluronic acid and glycerin. This will ensure that you don't use anything that could potentially cause or worsen your breakouts. If your skin is particularly dry, higher glycerin content help hold hydration to the top layer of your skin, known as your epidermis, and reduces flaking without breaking you out. Limit Sun Exposure Sun exposure can cause skin inflammation and worsen existing acne breakouts. To prevent this, make sure to wear sunscreen when outdoors, even on cloudy days. Choose an SPF 30 or higher with broad-spectrum protection that blocks UVA and UVB rays. Also, avoid spending too much time in the sun during peak hours (between 10 am and 4 pm). Try Topical Active Ingredients Do you have severe acne? If so, consider trying topical products with salicylic acids or retinol. These ingredients can help: Reduce inflammation Unclog pores Fight bacteria Look for creams or gels that contain these active ingredients and apply them directly to the affected areas of your skin. Make sure to start with a lower concentration and work your way up, as these ingredients can be drying. Always talk to a professional to see if retinol is safe for regular use (avoid direct sun and do not use it when pregnant). Talk to a Professional and Learn How to Deal with Acne Today If you have constant breakouts and want to learn how to reduce acne, it may be time to consult a professional. A naturopathic doctor can help diagnose the root cause of your clogged pores and acne-prone skin and create a customized treatment plan. At Platinum Health & Wellness, Dr. Courtney Holmberg, ND, specializes in creating personalized solutions using evidence-based treatments to help people learn how to prevent acne and pimples and take control of their skin health. Call 647-351-7282 to book your appointment and start on the path to clear skin!
- NUTRITIONAL DEFICIENCIES AND MENTAL HEALTH: HOW THEY ARE CONNECTED?
Depression is a mental health condition that can make eating regularly or preparing nutritious meals to feel impossible. Unfortunately, besides medication, our system has little support to help patients diagnosed with depression, so you might feel overwhelmed with how to approach it or discouraged even to start. Many doctors use talk therapy and medications to treat depression, but did you know that nutritional deficiencies and mental health are strongly linked? While supporting depression takes much more than eating your fruits and vegetables, arming yourself with the knowledge about how your diet can affect your mood, you can start to take more control over your mental health. Let's dive into how what you eat affects your brain and mood. How Does Nutrition Affect Depression? Proper nutrition is essential to your mind and body's well-being, and it can help reduce the severity of some depressive symptoms. Nutritional deficiencies, especially vitamin D, B12, and iron, increase your risk of depression. A nutrient deficiency may also lead to a hormone imbalance, which is common among those with significant depression. First, if you’ve recently been diagnosed, start by asking your medical doctor or naturopath to check in on common nutrient deficiencies like iron, b12, and vitamin D since one in three depression cases is linked to defects. Did you know that depression, anxiety and insomnia, among other neurological disorders, all correlate to neuroinflammation? That's right; depression is inflammatory. The processed foods common in North American diets do nothing to help this, including: Highly processed, low-fibre foods Trans fats (margarine, hydrogenated oils) Canola, corn, soybean oils High glycemic foods that spike your blood sugar levels Artificial sweeteners like Splenda and high-fructose corn syrup Meat and dairy-raised or grain-fed diets GMO crops, like soy and corn What Nutrients Foster Healthy Brain Function? A few primary nutrients play a significant role in fostering a healthy brain. By choosing foods naturally rich in these nutrients and supplementing your diet with vitamins where necessary, you can make a big impact on your mental health. Protein Protein is for much more than simply building muscle mass — it also promotes neurological health. The amino acids in protein provide the critical building blocks for both your hormones and your neurotransmitters. If you aren’t eating enough protein, you may lack the amino acids key to producing your ‘happy hormones’ like serotonin and dopamine. The higher availability of these two hormones is essential in counteracting depression. Vitamin D For people who spend a lot of time indoors or live in climates with less sun, vitamin D deficiency is a common problem (it's suggested that ⅔ Canadians are deficient). Low vitamin D levels are often linked to depression due to the high accumulation of vitamin D receptors in the same brain area that depression affects. Vitamin D is also a hormone modulator, assisting in generating some of the essential hormones that keep us feeling content. Spending some time every day in sunlight is an excellent way to get more vitamin D. Eggs, mushrooms, and fatty fish are also reliable sources of vitamin D; however, its rarely enough to keep you from deficiency. Talk to your naturopath about testing your levels and how much is ideal for supplementation. Omega-3 Fatty Acids Interestingly, depression incidents are reported to be less common in groups that consume more fatty fish, which sparked an investigation into Omega 3’s and their role in reducing depression. And to no surprise, according to studies, Omega-3 fatty acids support brain health. While the mechanism between depression and Omega-3 isn’t yet conclusive, its proposed benefits come from omega-3’s ability to travel through the blood-brain barrier easily, interact with mood-related molecules in the brain, and provide inflammatory modulating effects. Adding fatty fish, nuts, and seeds like walnuts and chia seeds to your diet can increase your body’s omega-3 saturation and improve mood. You can also supplement Omega 3’s. However, the ratio and concentration do seem to matter. The most effective Fish Oil preparations appear to have at least 60% EPA relative to DHA, with benefits typically best seen with over 1000 mg of EPA per day. Get Your Mental Health Back on Track with Nutrition Whether you need more vitamin D or other nutrients in your diet, a healthy diet can be the first step toward a happier lifestyle. However, it is essential to acknowledge that making changes or finding the motivation to do so when in a depressed state can feel daunting. However, support is available. To learn more about where to start in taking control of your diet and ruling out nutritional deficiencies which may be impacting your mental health, contact Dr. Courtney Holmberg, ND, at (647) 351-7282 today to book a consultation.
- DO YOU HAVE A ‘HORMONAL IMBALANCE’?
The term 'hormonal imbalance' gets thrown around a lot these days. If you've scrolled through social media or listened to any health related podcasts recently, you're sure to have come across this buzz word. But what are we actually referring to when we say hormonal imbalance? Are they talking about sex hormones, metabolic hormones, or adrenal hormones? Is this a symptomatic imbalance or a clinical one? It's important to know what we're referencing when we talk about hormones since the term itself is an umbrella for numerous communication molecules that float through the body. Let's spend a moment and actually break down the most important hormonal systems in your body, and identify where imbalances may exist. Sex steroid hormones Your sex steroid hormones, often referenced as your reproductive hormones, kick in at puberty and control - you guessed it - our reproductive systems. Imbalances in these systems can lead to acne, hair loss, PMS symptoms, low lidibo, and in more significant cases, irregular or missed periods, infertility issues and extreme fatigue/mood issues. The most common issue facing young women in my practice is hyperandrogenism, or excessive production of testosterone, leading to acne, hair loss and darkened hair growth. It’s often caused by conditions like PCOS or excessive stress, but in some cases it can also be genetic. Correcting ovulation patterns and dealing with the mental and physical stressors placed on the body are the most common alternative to oral birth controls and androgen suppression medications in these situations. PMS is also a common symptom of hormonal imbalance, although its important to differentiate if the symptoms is being caused by hormones, or just made worse by a change in hormones. Its common for women to have lower progesterone levels compared to their estrogen, resulting in PMS symptoms presenting the last 7-10 days of their cycle. This again is correcting by supporting ovulation and managing aggravating factors like stress, lack of sleep and exercise. Metabolic Hormones There are numerous hormones that control your metabolism, but the most impactful ones are insulin and thyroid hormones. Insulin is a reactive hormone, meaning in only released in the presence of glucose in the blood stream, and the most those levels go up and down, the more the cells start to gradually ignore insulin signals. This means cells cannot update glucose as energy, resulting in weight gain and fatigue as the primary symptom. Weight gain and fatigue can also be as a result of low thyroid hormones. Your thyroid products hormones that control the rate in which your body burns fuel, amongst other things, so a lack of it slows things down. If you’re experiencing any of these symptoms, these would be important hormones to look into getting tested. Adrenal Hormones Cortisol, epinephrine and norepinephrine are a few of the corticosteroid hormones are made in the small organ that sites above your kidneys, known as your adrenals. Overstimulation of this organ from both physical and mental stressors can lead to an overproduction of these hormones, presenting as anxiety, panic, lack of appetite, insomnia, and so on. Simultaneously, a lack of these hormones can cause extreme fatigue and burnout. Your adrenal hormones have a large influence on the rest of your endocrine system, which is often why stress makes all hormonal issues much worse. Testing for hormonal issues You many have been told by your MD that blood work for your hormones will not provide answers, and in many cases, that's correct. Unfortunately, unless is there something pathologically wrong (like PCOS or an adrenal crisis), its hard to test for these issues via standard blood work, since most hormones are to limited in the blood stream to identify more functional imbalances. This is where more sensitive testing like saliva and urine may be of value, and I emphasize the may. Not all issues can be ruled in or out via hormone assessments, and that's why its important to talk an experienced Naturopathic Doctor about options for testing and if its right for you. How to regulate hormones naturally I always advise starting with these simple steps to address hormone imbalanced before you involve supplementation. Protein helps you feel fuller for longer and is critical when trying to balance your metabolic hormones. Eat around 20 to 30 grams with every meal, or for certain people, your body weight in lbs. Eat fresh vegetables (especially greens), and fermented foods to support the beneficial bacteria in your gut. This combats insulin resistance and boosts your immunity. Cut out sugar as far as possible to protect your gut and stabilize your metabolic hormones Improve the amount of fibre you eat to improve insulin sensitivity, manage your hunger, and feed your gut Use your body as feedback for exercise. If you’re constantly injuring yourself or shorting yourself on sleep just to get a workout in, consider the impacts that has on adrenals. If you’re feeling tired a lethargic, considering adding in low intensity movement to pick up your energy. Find ways to relax and combat stress to reduce cortisol levels. This may also help you lose weight as excess cortisol interferes with insulin production. Get the recommended 7 to 8 hours of sleep at night to reduce hunger, improve insulin sensitivity, and regulate endocrine production. Speak to Dr. Courtney Holmberg About More Natural Ways to Balance the Endocrine System Learning how to properly balance hormones can make significant changes to your life, but also be mindful to be objective when considering whether or not your hormones may play a role in your symptoms. To learn more about hormones and their role in your health, as well as discuss proper hormone testing if necessary, contact Toronto Naturopath, Dr. Courtney Holmberg at 647-351-7282 or schedule your appointment online today.
- RELIEF FOR IRRITABLE BOWEL SYNDROME (IBS) WITH PROBIOTICS
Irritable bowel syndrome (IBS) is a common GI disorder impacting roughly 1 in 5 Canadians, with our incidence rate being one of the highest in the world (18% vs 11% globally). However, despite its high prevalence, health care costs and impacts on people's quality of life, our understanding of the true ‘root cause’ of IBS is limited. It often occurs in association with gut infections (often referred to as post-infectious IBS), bacterial overgrowths (also known as SIBO), or heightened stress (people exposed to stressful events, especially in childhood, tend to have more symptoms of IBS). Fortunately, outside of impacts on quality of life, the good news is IBS doesn't cause changes in bowel tissue or increase the risks of colorectal cancer. Irritable bowel syndrome can cause the following symptoms, which may differ in each person. Cramping Abdominal pain Bloating and gas Changes in how often you have a bowel movement Diarrhea Constipation Generally speaking, the muscles of the colon of people with IBS tend to contract more than in people without this condition, causing cramps and pain. These problems cause the digestive tract to become very sensitive, and this is where diet and lifestyle changes come into play Diagnosing IBS The diagnosis is considered a ‘diagnosis of exclusion’, meaning all other causes of symptoms must be ruled out to rule in IBS. It’s important to work with your clinician to complete the proper testing to rule out other factors, such as infection, bacterial overgrowth, celiac disease, IBD and other overlapping pathologies. However, the most up-to-date studies suggest the microbiota in our gut plays a key role in the pathophysiology of IBS and poses the question if probiotics can truly help. Which probiotics could help IBS Research has suggested that an important factor in the management of IBS is to support a balance of the gut-brain axis, and probiotics in the correct doses + correct strains can assist with this . The two most well-researched species of probiotics are “Lactobacillus” and “Bifidobacterium,” which have not only been shown to aid the digestive system but also assist the immune system, provide anti-inflammatory benefits to the gut, strengthen the intestinal barrier and many more influences, including improvements in mood and metabolism. However, strain specificity matters and not all probiotics may work. Lactobacillus plantarum 299v The literature demonstrates some really promising results with this probiotic strain. L. plantarum 299v has been shown to lower inflammatory markers associated with cancer risk, prevent c. difficile diarrhea in antibiotic recipients, and improve IBS symptoms including gas, bloating, abdominal pain and irregular stools. A recent review of the research also concluded that the intake of L plantarum 299V at only 5-10 billion CFU per day was shown to significantly relieve abdominal pain and flatulence, and normalize stool in IBS sufferers, providing significant improvements to their quality of life with only 4 weeks of use . Bifidobacterium Infantis (also referred to as bifidobacterium longum) A meta-analysis of the probiotic strain b. infantis (a strain commonly found in many IBS targeted probiotic combinations) also concluded that when used in combination with other composite probiotics, b. infantis significantly reduced abdominal pain, bloating and distension in IBS sufferers. Not only were symptoms improved, but there is also data suggesting that this strain of flora assists in increasing plasma concentrations of tryptophan, the precursor of serotonin . While studies don’t show significant benefits with the use of antidepressant therapies (aka SSRIs) in the management of IBS, serotonin delivered locally by bacteria may be more effective. Studies also prove that probiotics can help, even in their inactive state. One study looked at the use of an inactive probiotic in women with IBS, and 30% of the women reported an improvement in pain and less discomfort within a three-week or more period compared to those taking the placebo. When treating IBS, of course, we cannot exclude diet and stress management as a part of a well-rounded treatment plan (read more about the FODMAPs diet for IBS here), but it's evident that the right probiotics have a largely positive effect. To learn more about IBS, proper diagnostic assessments, and treatment options for irritable bowel syndrome, please contact Toronto Naturopathic Doctor, Dr. Courtney Holmberg at 647-351-7282 to schedule your appointment today. Other References: Lovell RM and Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: A meta-analysis. Clin Gastroenterol Hepatol. 2012 Jul;10(7):712-21.e4. Pimentel M, Lembo A. Microbiome and Its Role in Irritable Bowel Syndrome. Dig Dis Sci. 2020 Mar;65(3):829-839. doi: 10.1007/s10620-020-06109-5. PMID: 32026278. Kaźmierczak-Siedlecka K, Daca A, Folwarski M, Witkowski JM, Bryl E, Makarewicz W. The role of Lactobacillus plantarum 299v in supporting treatment of selected diseases. Cent Eur J Immunol. 2020;45(4):488-493. doi: 10.5114/ceji.2020.101515. Epub 2021 Jan 25. PMID: 33613097; PMCID: PMC7882405. Andrew P. Allen, Gerard Clarke, John F. Cryan, Eamonn M. M. Quigley & Timothy G. Dinan (2017) Bifidobacterium infantis 35624 and other probiotics in the management of irritable bowel syndrome. Strain specificity, symptoms, and mechanisms, Current Medical Research and Opinion, 33:7, 1349-135. https://www.healthline.com/nutrition/9-signs-and-symptoms-of-ibs https://www.frontiersin.org/articles/10.3389/fmicb.2019.01136/full#
- PCOS UNCOVERED: HOW TO RECOGNIZE, TEST, AND TREAT PCOS NATURALLY
Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal health issues in women, affecting an estimated 1 in 10 women of reproductive age. Many women are first diagnosed when they are having difficulty trying to conceive, but PCOS presents with many other symptoms, like hair loss, acne, hirsutism, and weight gain. These symptoms can affect a woman's health even beyond trying to get pregnant. What Causes PCOS? The exact cause of Polycystic Ovary Syndrome is unknown, though it is thought that genetics play a major role. PCOS is a complex disorder that presents itself as a group of symptoms resulting from hormonal imbalances -- usually an excess of androgens like testosterone and high levels of insulin. These symptoms include: Irregular menstrual cycles. Typically, women with PCOS will have long cycles (often longer than 35 days), missed periods, or no period at all. Some women may have shorter cycles. Ovarian cysts. Hirsutism is abnormal hair growth on the chin, face, and other areas usually seen in men but not in women. Male-pattern hair loss on the scalp. Acne on the face, chest, and upper back. It may be cystic acne. Darkening of skin on neck creases, under the arms, under the breasts, and in the groin. Skin tags Weight gain and difficulty losing weight. Insulin Resistance and PCOS Androgens – sometimes referred to as "male hormones" – are produced by both men and women. Women produce androgens in smaller amounts. Higher-than-normal levels of androgens are a common indicator of PCOS, and often attribute to the symptoms of hirsutism and acne. When women start producing androgens, like testosterone, in higher than normal amounts it can lead to metabolic interference, an inability to lose weight, and weight gain. Excess weight is highly correlated to insulin resistance. Between 65-70% of women with PCOS will experience insulin resistance . What Is Insulin Resistance? Insulin is a hormone that regulates the level of glucose in your blood. Upon eating, insulin is released to allow the cells to absorb sugar from food to either use it for energy or store it for later use. When a person is insulin resistant, their body ignores the signals, ultimately leading to further insulin release and a worsening of the vicious cycle. When sugar isn't utilized and stays high in the bloodstream, it ultimately gets stored as adipose tissue, also known as fat. Insulin resistance can lead to: Type 2 Diabetes Cardiovascular disease Non-alcoholic fatty liver disease Higher risk of developing certain types of cancers, like uterine and bladder cancer Fat and PCOS One thing to remember is that fat is not just storage tissue but in fact an "endocrine organ". We're good a storing fat, since fat ultimately is an efficient way to store energy. It actually regulates our appetite through a hormone called leptin. It regulates inflammation, as well as our sensitivity to insulin and blood sugar control. Believe it or not, healthy fat tissue actually provides us benefits, such as hormones like adiponectin and cytokines that reduce inflammation. However, dysfunctional fat cells, commonly seen in PCOS, are enlarged and sometimes necrotic. As a result, the dying fat cells produce inflammatory markers with affect our immune system and hormones. What Tests are Essential in PCOS The following lab markers should be tested in PCOS to help understand the root of the problem, your likelihood of fertility, and your course of treatment. All these markers can be ordered via your MD, endocrinologist, or naturopath. FSH (day 3 of the cycle, if cycling) LH (day 3 of the cycle, if cycling) Estradiol (day 3 of the cycle, if cycling) Progesterone (day 21, or 7 days post-ovulation) Cortisol Free testosterone, total testosterone Prolactin DHT – dihydrotestosterone SHBG – sex hormone binding globulin HbA1C, fasting glucose, fasting insulin DHEAS Ferritin TSH, free T4, free T3 25-hydroxy Vitamin D Managing Insulin Resistance and PCOS Weight loss is evidently a key component to PCOS management. This becomes a large source of frustration for many patients with PCOS since as previously mentioned, one of the primary symptoms of this disorder is an inability to lose weight. Fortunately, treating a major root of the problem – insulin resistance – can mitigate many of the other symptoms of polycystic ovary syndrome. While diet and exercise are critical, the first step to losing weight for PCOS and insulin resistance is to understand what foods raise insulin levels rather than glucose levels. Furthermore, the inflammatory properties of foods also matter. A specialized diet is often required to get insulin levels back to normal, such as a ketogenic diet, a low glycemic index diet, or even a food insulin-demand diet. No one diet works for everyone, which is why I will always make suggestions based on individual needs and situations. Supplements can also aid the progression of insulin sensitization by reducing inflammation and optimizing glucose absorption. N-Acetyl-Cysteine, which is a precursor to glutathione in the body and is a powerful antioxidant and protector of inflammatory stress from insulin, ultimately shows benefits in PCOS. Inositol is one of my favourite therapies, as it has the ability to improve insulin sensitivity, and is one of the main intracellular messengers for insulin use within the cell. Clinic studies show higher doses of vitamin D improve glucose metabolism in lipid profiles in individuals with PCOS vs standard dosing recommendations . Minerals like magnesium, calcium, and zinc have also been shown to improve inflammation. Ahmadi et al. (2017) also recently determined that probiotics, which promote beneficial effects on immune function and inflammation, have been shown to have favourable effects on weight loss, insulin resistance, TG and cholesterol . Vitex, also known as Chaste Tree, contains the constituent Agnugol, which affects opiate receptors in the brain as well as dopamine. Menstrual cycle regulation from Chaste Tree has been shown to be as effective as metformin in clinical trials with fewer reported side effects . Lastly, stress management is critical. High levels of cortisol affect insulin control and thyroid function. A treatment plan that overlooks stress and anxiety is missing a large piece of the puzzle. As you can see, PCOS is a complex, multifaceted syndrome. Managing PCOS symptoms and insulin resistance requires a multifaceted approach. If you suspect you have PCOS or are experiencing any of the symptoms of PCOS, please feel free to contact Toronto naturopath, Dr. Courtney Holmberg at 647-351-7282 to schedule a consultation today. References: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277302/ https://www.ncbi.nlm.nih.gov/pubmed/28679142 https://www.ncbi.nlm.nih.gov/pubmed/28142296 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5296515/
- PROBIOTICS FOR HISTAMINE INTOLERANCE: EVERYTHING YOU SHOULD KNOW
Histamine intolerance affects millions of people every year, and many are unaware of its symptoms or that they may be presented with it. The connective tissues in your body produce histamine to help organs, muscles, and nerves receive and deliver messages to your brain and immune system. For example, histamine signalling will trigger your brain tissues to release pent-up stomach acids to process the foods you eat. It also helps the immune system response by drawing attention to damaged tissue that requires repair. Histamine intolerance comes from an overproduction of the histamine molecule from mast cells and basophils. Most patients with histamine intolerance symptoms present with hyperinflated histamine levels and/or no way to metabolize it, leading to symptoms such as sinus issues, intestinal permeation, chronic headaches, anxiety, fatigue, hives, nausea, and digestive problems. It's important to clarify that histamine intolerances are very different than mastocytosis and mast cell activation syndrome. In these disorders, patients either genetically produce too many mast cells, or the mast cells are hyper-reactive to triggers and release too much daily histamine. These disorders are managed differently and you should always first speak to your doctor or naturopath for a proper diagnosis. While histamine presents widely throughout the body and serves many functions, the abundance of histamine production and uptake inside the digestive system has led researchers to investigate the root causes of excess histamine and the potential for probiotic treatment in stabilizing it. Probiotics for histamine intolerance offer significant opportunities to reduce histamine production and treat histamine intolerance. What is a Histamine? Histamine release occurs naturally inside your body as one of the five major biogenic amines. These five neurotransmitters, dopamine, norepinephrine, epinephrine, serotonin, and histamine, regulate brain functions and endocrine responses. Your cells produce histamine to send signals from your body to your brain as a part of complex biochemical reactions, particularly in digestion and gut motility. They also produce histamine to stimulate the immune response, activating your white blood cells to defend you from allergens or other threats. What Causes Histamine Intolerance? Your body produces histamine for its own use, and when your body can’t produce enough enzymes to break down all the histamine in your system, your histamine levels rise, creating an imbalance. This causes every mast cell in your body to produce the enzyme to break it down, known as diamine oxidase or “DAO”. DAO is responsible for breaking down the histamine compound in your food, and a lack of it creates a histamine-derived imbalance or build-up. Symptoms of elevated histamine include: itchy, flushed skin diarrhea & abdominal pain nausea headaches congestion, running/itchy nose & eyes dizziness heart palpitations/anxiety You may not be aware of it, but you have relatively high amounts of naturally occurring histamine in your diet every day. Foods high in histamine include: Fermented foods and beverages like Sauerkraut and wine Processed meats Aged cheeses Eggplants and spinach Avocados And dried fruits Some foods, including alcohol, energy drinks, black tea, and green tea, block DAO, preventing it from breaking down histamine. While other factors, including genetics and medications, may lower DAO production, diet factors significantly decreased DAO activity. It's important to recognize that a histamine-rich diet enhances the production of gut bacteria in healthy individuals, and is not an unhealthy way to eat. In fact, histamine-rich foods are usually the highest in naturally occurring probiotics. However, when your system falls out of balance, multiple sources of histamine build up and trigger histamine intolerance. The problem arises when dietary intake and bacterial histamine production combine at such staggering levels that human mast cells can't manufacture enough DAO to process the overflow. Disorders like SIBO, or small intestinal bacterial overgrowth, can also exacerbate histamine intolerance because they not only generate their own histamine release but damage the area of the gut lining that creates a large supply of the body’s DAO enzyme. Therefore, people with small intestinal bacterial overgrowth or SIBO are at a much higher risk of presenting with histamine intolerant symptoms. Antihistamine Probiotics vs. Histamine Intolerance Because histamine production is deeply connected to gut bacteria levels, researchers have been looking into histamine-reducing probiotics as a treatment. Treatment of histamine intolerance focuses on ways to limit histamine intake and remove excess histamine from your system. Diet plays an important role in limiting histamine sources, but research has uncovered more about the interplay of gut bacteria in health. Using probiotics for histamine intolerance treatment demonstrates improved outcomes for people suffering from histamine intolerance. So much of your gut health depends on your gut biome. These microscopic bacteria coexist in your digestive tract and help your body break down and process foods. Some strains of beneficial gut bacteria, known collectively as probiotics, display histamine-increasing properties, while others offer histamine-lowering effects. The role of probiotic bacteria in curbing histamine overproduction is a rapidly advancing area of mast cell research, and you can find numerous studies connecting probiotic strains to lowering histamine presentations (or increasing it, for that matter). For example, because histamine is a biogenic amine, physicians have been looking to other naturally occurring biogenic amines, such as lactic acid (and lactic acid-producing bacteria) in its role in histamine intolerances. It may come as a surprise, but any of the common ‘good for you’ probiotics from the lactobacillus family are being investigated as possible aggravators due to their high lactic acid production in food. However, the impacts on histamine depend on the strain, so this does not apply to all strains of a specific species or genus. Alternatively, low-histamine probiotics activate anti-inflammatory agents in the mast cells, help stabilize mast cells, and down-regulating the sensitivity of histamine receptors. Many of these flora are found in the Bifidobacterium genus. Some histamine-lowering strains include: Lactobacillus plantarum Bifidobacterium longum - helps improve gut barrier and assist in histamine degradation Bifidobacterium infantis Lactobacillus rhamnosus And physicians have been looking into the probiotic lactobacillus reuteri, which they derive from histamine itself Moreover, some histamine-increasing probiotics include: Lactobacillus casei Lactobacillus Bulgaricus Streptococcus thermophilus Lactobacillus delbrueckii Lactobacillus helveticus More so, some probiotics are classified as histamine neutral, or helpful at lower doses, such as lactobacillus acidophilus when taken under 1 billion CFU per day. Histamine-lowering probiotics muffle histamine signals and compounds like the probiotic b. longum display clinical benefits in lab tests against allergies. However, people are different, and we all have unique levels of gut flora in our stomachs and intestines, so probiotic supplements don't have a uniform effect on all demographics. An anti-inflammatory diet regimen that avoids histamine-rich foods lays the basis for reducing histamine levels. Incorporating probiotics that assist in histamine prevention or removal can present meaningful improvement and symptom reduction in patients suffering from histamine intolerance. In all cases, you should work with your doctor to confirm your diagnosis and develop personalized treatments for histamine intolerance. Many factors in your health composition and diet limitations affect treatment and results. For example, consuming the aforementioned DAO-blocking foods, such as alcohol, can create confounding impacts when using probiotics to manage histamine symptoms. Learn More About Histamine Intolerance Treatment Research indicates that readjusting your gut flora with low-histamine probiotics can reduce inflammation, alleviate symptoms, and reduce the effects of seasonal allergies. Treatments that include a low-histamine diet combined with histamine intolerance probiotics work together to improve gut health in people diagnosed with histamine intolerance. Most patients with histamine intolerance tend to have an overabundance or bacterial deficiency in their gut flora. The key to resolving symptoms is to eradicate the aggravates (both food and flora) and restore a healthy bacterial balance to the ecosystem. Furthermore, as described above, taking the wrong probiotic supplement can worsen your condition, as they promote histamine production. If you want to learn more about probiotics or the management of histamine intolerance symptoms, contact our Toronto Naturopath, Dr. Courtney Holmberg ND by calling (647) 351-7282 today.
- PCOS AND PREGNANCY
Odds are, you know at least one woman around you who has PCOS. It is a common condition affecting women of reproductive age, with prevalence rates approximated to be around 1.4 million in Canada alone. Upon diagnosis, most women’s first question is ‘how will this impact my fertility’? Unfortunately, there is no short answer, but the general conscience is that while PCOS is unlikely to cause infertility, and can certainly make it harder to conceive, and increases the risks of secondary complications. However, the good news is there are numerous ways to improve PCOS to ultimately assist in a woman’s chances of conception and lead to a healthy pregnancy if she has PCOS. Let’s learn more about PCOS and how to improve your chances of getting pregnant with it. What Is PCOS? PCOS or polycystic ovary syndrome is a hormonal condition where the ovaries produce an elevated amount of androgen hormone or male sex hormone. Androgens are naturally present in females in small amounts. However, increased levels can lead to failed or delayed ovulation, irregular periods, and other symptoms such as darkened hair growth and acne. PCOS can result in delayed ovulation, thus causing irregular or no periods for weeks to months. Ovulation is part of the menstrual cycle where follicles in the ovaries release a mature egg, and its timing is arguably one of the most important variables to successfully conceive since the released egg is only viable to be fertilized for approximately 24 hours. In many patients with PCOS, the egg releases at erratic points in the cycle, or sometimes does not release at all, therefore remaining inside the ovaries in the form of a cyst (thus polycystic ovary syndrome). Irregular timing, failed ovulation, or poor quality ovulation all present challenges when trying to fertilize, thus making it more challenging for patients with PCOS to conceive. Symptoms of PCOS Women of any age after puberty, from 15 to 44 years, can develop PCOS. Let us look at the symptoms of it: Irregular, absent periods Weight gain Acne Excessive hair fall Hair thinning Prolonged bleeding during periods Causes Of PCOS The true causes behind PCOS are not yet discovered. However, the literature suggests some factors that are linked to PCOS as follows: 1 - Genetics If someone in your family, such as your mother or relative, has PCOS, you are more likely to develop it correlates to genetics. 2 - Excessive Androgen The female body produces androgens or ‘male patterned hormones’ in certain amounts. However, the higher the androgenic hormones the higher the risk of PCOS. 3 - Overweight Or Obesity Women with obesity and poor BMI are at greater risk of having PCOS due to the impacts of insulin. The vice-versa is also true; women with PCOS tend to gain weight easier. An optimal diet and exercise routine can assist in regulating ovulation if are planning a baby. 4 - Higher Levels Of Insulin As previously mentioned, women with PCOS face trouble with increased insulin levels due to failed insulin uptake. Insulin is known to regulate ovarian function, so irregular levels cause unpunctual ovulation. How To Get Pregnant With PCOS? PCOS can affect fertility and conception in women, however, it often does not mean you cannot get pregnant. Assist the regulation and quality of your ovulation by keeping the following things in check: 1 - Do your best to maintain a healthy weight I list this with a grain of salt, as I see firsthand in practice how hard some PCOS patients struggle to maintain or lose weight despite doing all the right things. This is where further investigation into metabolic function and other exocrine organs is necessary. However, for those with PCOS who do not maintain and balanced diet and exercise routine, doing so can largely improve your chances of pregnancy, and secondary complications during pregnancy such as gestational diabetes, miscarriage, pre-eclampsia, etc. 2 - Track Your Ovulation To stay aware of your fertile days, track your periods and ovulation with the help of tracking apps, or more accurately, using Luteinizing hormone (LH) strips. Remember, the accuracy of these apps isn’t 100% (it's based on statistical averages) and was far from ‘average’, so using LH strips, temperature monitoring, and cervical mucous monitoring can produce significantly more accurate results. 3 - Blood Sugar Levels Make sure to get your blood sugar levels checked by a doctor. Maintaining healthy blood sugar levels is crucial for pregnancy, both prior to conception and during. 4 - Nutraceuticals Speak to your naturopathic Doctor in Toronto about supplements that can help with fertility and regulating your cycle. There are endless studies that now show many nutraceutical products such as inositol, NAC, CoQ10, folic acid, and vitamin D, amongst many others can help improve insulin sensitivity, regulate ovulation, and improve the health of the uterine lining, which is great for all women with PCOS, despite whether or not they’re trying to conceive. There are also numerous supplements that are NOT safe during pregnancy, so ensure to speak to your Naturopath before taking any of the following to confirm the safety of use and proper clinical dosages. Unfortunately, there is no cure for PCOS to date, and it is often not self-limiting (goes away on its own). But you can manage the symptoms with a number of the methods we just mentioned. Eat a balanced diet that is low in refined carbs but high in complex carbs. Keep your weight healthy and consult a practitioner for prescribed medications and professional advice. Lastly, While PCOS is a common condition, and many women will move in and out of symptomatic states throughout their life, it isn’t one that you have to continue to suffer from. For more information about PCOS, or if you need to advise on improving your fertility, please feel free to contact Dr. Courtney Holmberg, ND at 647-351-7282 to arrange a consultation today.
- HISTAMINE INTOLERANCE: SYMPTOMS, CAUSE, AND TREATMENT
Histamine intolerance symptoms are experienced by many people, although it still remains relatively misunderstood (that being said - research on the topic is quickly expanding). Its severity ranges from more severe IgE-mediated symptoms to milder intolerances to fermented or aged foods containing high histamine levels. Here, we’ll examine more about this condition, its causes, and what you can do to alleviate symptoms. Allergies form when the immune system improperly identifies an otherwise harmless molecule like a dust particle or pollen as a danger, mounting an immune response and producing the symptoms we’ve come to recognize as ‘allergies”. What Is Histamine Intolerance? Histamine intolerance is when the body has trouble with histamine clearance, either from excessive production or difficulty breaking it down. Since major of mast cells line our skin and mucous membranes, most symptoms include congestion, itching, and gastrointestinal disturbances. Since the disorder is driven by excessive histamine in the body, the cause could be as simple as consuming too many histamine-rich foods like alcohol, fermented foods, and dried/aged food, or in more complicated cases it could due to trauma to the intestinal lining and/or downregulation in the enzymes diamine oxidase (DAO) and histamine N-methyltransferase (HNMT) in the gut that assistance in histamine clearance. How is a Histamine Intolerance Diagnosed The simple answer is - clinically. While appropriate testing for histamine intolerances can be helpful to not only isolate the cause of the issue but support recovery long term, negative tests cannot always rule out an intolerance. This is where an experienced diagnostician can come in handy. It's also important to note that histamine intolerance is not an allergic reaction or food allergy, so traditional skin-scratch and allergy tests will be negative. What makes histamine intolerance so insidious is that it can manifest in many different ways. Common symptoms of histamine intolerance include: Wheezing/shortness of breath Hives or dermatographia Eczema Fatigue Bloating Diarrhea Heartburn/Reflux Irregular/painful menstrual cycle Headaches Nasal congestion/itchy eyes and nose Increased anxiety An elimination diet and challenge remain one of the best ways to know if you have histamine intolerance. Physicians may also check the levels of histamine in your bloodstream or take a skin biopsy, but this type of testing is more effective for conditions like mast cell activation syndrome. The DAO enzyme can also be measured, however as mentioned previously, normal results do not rule out an intolerance. Lastly, secondary histamine intolerances are more common in individuals with Irritable bowel syndrome, inflammatory bowel syndrome, dysbiosis or an overgrowth of bacteria in the gut. This is where SIBO testing and stool testing should be considered. Treatment with a Low Histamine Diet Regimens Since histamine intolerances are a by-product of how your body processes dietary and internal histamine, eliminating dietary intake can keep your levels below symptomatic thresholds. However, while eliminating high-histamine foods from your diet may seem like a simple solution, it can also be an overwhelming and restrictive process. As foods age, they increase in histamine content. This makes foods like smoked and aged meats, cheeses, vinegar, wine and fermented foods naturally high in histamine. Also, longer shelf life foods, previously frozen, and ever leftovers will also typically have higher histamine contents. Also, as you can see, the list can grow quite large, and whether or not we can achieve an absolute histamine-free diet becomes debatable. This is where I often recommend exploring why a histamine intolerance occurred in the first place. Since we know histamine intolerances are more common in people with gastrointestinal issues, this is often where I start. Furthermore, probiotics, antioxidants and vitamin C have all been shown to have favourable impacts on mast cell stabilization, which can expedite recovery over the long term. To learn more about histamine intolerances, proper diagnostic assessments, and treatment options, please contact Toronto Naturopathic Doctor, Dr. Courtney Holmberg at 647-351-7282 to schedule your appointment today.
- LOW FODMAP DIET FOR IRRITABLE BOWEL SYNDROME
Irritable bowel syndrome (IBS) is the most common gastrointestinal disorder worldwide, affecting more than 5 million Canadians each year (that's 1 in every 6 people). It includes symptoms such as indigestion, bloating, excessive gas, constipation, and/or diarrhea. However, a proper diet is one of the ways IBS can be managed. A common strategy has always been to incorporate ‘healthy’ food and avoid the ones that worsen the symptoms, however, some are surprised to find out that a diet rich in fruits and vegetables can sometimes actually make symptoms worse. This is where we look at something called the low FODMAP diet, which has been clinically proven to help ¾ of IBS sufferers. Let’s learn more. In this diet plan, the food items are classified as low, moderate, and high food. People with IBS must avoid high foods and consume low foods to determine a decrease in symptoms. However, if a person consumes low food excessively for long periods of time, it can also be harmful to gut microflora and increase your risk of nutrient deficiencies, so it's always important to talk to your doctor, naturopath or dietician about how long to avoid these foods, when to determine benefit and how to reintroduce. How Does A Low FODMAP Diet Work? A low FODMAPs diet aims to help you learn which foods (if any) you do not tolerate and which are the trigger for your IBS. The diet consists of a 3 step process, as follows: 1 - Elimination This phase can range from 3 to 8 weeks, depending on the person’s health and condition. In this, the individual is required to eliminate all high FODMAP food from their diet. Remember, the FODMAP list is extensive and can restrict some key nutrients for some individuals, so it’s always best to work with a professional through this phase. 2 – Reintroduction If after elimination, the symptoms significantly reduce or resolve, it’s safe to conclude that one or more high FODMAP foods are a trigger for IBS symptoms. You then must start incorporating FODMAP foods into your diet in a systematic way to determine the source of the intolerance. Generally, a person must eat the FODMAP foods at least once every day to every other day for ~3 servings to identify the trigger foods, increasing the quantity of the food each time. Monitoring symptoms through exposure will help determine which sugar groups are safe and which ones are not. 3 – Maintenance Now that the trigger food is traced, a person can return to their original diet while limiting the food that produces the IBS symptoms. At this point, most people are able to return to their original diet (minus a few possible avoidances) without symptoms. Key Foods To Avoid Vegetables: mushrooms, asparagus, cauliflower, beetroot, onions, and garlic Fruits: cherries, mangoes, watermelon, peaches, pears, apples, and apricots. Dairy: lactose-containing cow milk, cottage cheese, yogurt, ricotta cheese, ice cream, and custard Grains And Cereals: rye, wheat, kidney beans, soy products, lentils, and chickpeas. Sweeteners: Honeys, agave nectar, high fructose corn syrup, cough medicine, sorbitol, and sugar-free gums. Many lists suggest slightly modified food restrictions, and the list you see above is very simplified. The most valuable resource I generally recommend for patients embarking on a FODMAP diet is the smartphone app made from Monash University called ‘Monash University FODMAP diet’. The guidelines of Monash University tend to be the most detailed and well-researched. The Bottom Line The low FODMAP diet plan is proven and has helped many people with Irritable bowel syndrome. However, make sure to contact a professional dietitian or Naturopath Doctor who is versed on the FODMAP restrictions before following any diet plan. Many people stick with the low FODMAP diet for a long time because it eliminates IBS and improves overall well-being, however, you must way out the benefits against the risk in every case. Resources: https://www.monashfodmap.com/ibs-central/i-have-ibs/starting-the-low-fodmap-diet/ https://www.monashfodmap.com/ibs-central/i-have-ibs/get-the-app/