If the herb known as Ashwagandha is foreign to you, you've come to the right place. This herb has actually been used for centuries in Ayurvedic medicine and is well-documented for its traditional uses and beneficial effects on sleep, energy, stress and cognition. The botanical name given to the herb is Withania Somnifera and it belongs to the Solanaceae family. Some know it by its common name of 'Indian Ginseng' since it originates in India. In India, Ashwagandha has been used for centuries. There are specific properties of the herb that are now being researched as a natural treatment for a variety of medical conditions. So far, research studies have discovered the herb contains properties that can help: Alleviate Arthritis Induce Sleep Reduce Inflammation Reduce Stress and Anxiety The herb is classified as an adaptogenic herb. This simply means it has the ability to help stabilize various physiological conditions and help the body establish better homeostasis. In addition, it helps normalize the “flight or fight” response we experience during extremely stressful situations. The many holistic effects of ashwagandha demonstrate the power of herbal medicine, which has been largely integrated into naturopathic treatments for decades. Let's explore the many wonderful benefits of ashwagandha. How Is Ashwagandha Used in Naturopathic Medicine? Ashwagandha is composed of many medicinal compounds such as amino acids, fatty acids, choline, alkaloids, and steroidal lactones. Given these properties, along with the ability to use the entire plant for therapeutic purposes, some of the benefits one could experience include: Brain Cell Degeneration Reduction: Research studies have suggested that improved memory and learning benefits could possibly be used to help people suffering from Alzheimer’s.An 8-week study in 50 adults showed 300 mg of Ashwagandha root extract twice daily significantly improved general memory, task performance and attention [1], making it a promising option for dementia and cognitive decline. However, Ashwagandha has cognitive benefits extending beyond preventing brain cell degeneration. Alongside this powerful effect, the root of the herb has been shown to increase focus, attention span, and short-term memory, suggesting this root could also be used to help you perform better at work or in school. Attention deficit disorder patients could consider supplementing medications with ashwagandha extract or transitioning to natural medicine altogether. Reduces Depression without Feeling Drowsy: When taken daily, Ashwagandha has been shown to lower cortisol levels by 28% [2], reduce stress by 44% [3], minimize anxiety by 69%, and improve depressive symptoms by 68%, which makes it better than some first-line anti-anxiety and antidepressant drugs at stabilizing mood and insomnia. The best part – it's generally without any side effects or withdrawal symptoms. Improved Thyroid Function and Weight Management: Studies have also been conducted on Ashwagandha and its effects on the thyroid gland. Using the herb on a regular basis has been shown to help support the conversion of thyroid hormones into their active form, helping certain people who have had either under-active or over-active thyroid glands [4]. Strengthens the Immune System: People that have cancer and are seeking treatment have used Ashwagandha to help boost their immune system response, which is usually lowered from chemotherapy. The herb has also been shown to help reduce fatigue and discomfort, while simultaneously helping protect against some of the negative side effects associated with radiation. and chemotherapy. Always consult your medical doctor and naturopath before using Ashwagandha if you are undergoing any of these treatments. Enhances Sexual Stimulation for Men and Women: For both men and women, who are experiencing a reduced sex drive, the herb has been used to increase sexual response. In addition, it has helped men with low sperm counts increase levels to help with conception. Furthermore, research has noticed some men have better testosterone production, which can be beneficial for those that have low testosterone levels. Helps Stabilize Blood Sugar Levels: Test tube studies have shown the herb to increase insulin secretion and improve insulin sensitivity in muscle cells [5]. Also, several human trials show improved blood sugar regulation in patients with diabetes [6,7]. One trial showed hypoglycemia benefits at 30 days of use equivalent to some medications without adverse effects [8]. Benefits Heart Health We already know that ashwagandha has powerful effects on reducing stress and anxiety. But its impact on health proves far greater than just making you feel more peaceful. Studies have proven that the evergreen root from the nightshade family can lower blood pressure and significantly improve outcomes for patients with hypertension. Supplementing your medications with this root may help maximize positive outcomes. The herb has also shown promising results on lipid profiles. For instance, using the herb has been shown to reduce “bad” (LDL – low-density lipoprotein) cholesterol levels [8]. Furthermore, healthy people without a personal history of heart disease can benefit from it too. The root helps prevent heart disease and improves general cardiac function, making it a great option for those with no current signs of heart disease but a high-risk family history. With its ability to lower blood pressure, bad cholesterol, and sugar levels, ashwagandha can positively affect heart health. For those struggling with heart disease, ashwagandha should be a top therapy to consider. Increase Energy Levels Fitness fanatics are always looking for supplements to aid their workouts. Even for more sedentary people, ashwagandha naturally boosts energy levels and helps with chronic fatigue syndrome. Try substituting pre-workout supplementals with ashwagandha extract, or use it to prepare you for work. Everyone can benefit from feeling more energized and active. Reduces Inflammation and Eases Pain Many people suffer from pain from arthritis and other chronic joint conditions. These frustrating ailments usually have few solutions and become a daily struggle for many. However, naturopathic medicines can address some of these symptoms. Ashwagandha can reduce inflammation and ease joint pain. Use it to ease the impacts of your arthritis or to aid soreness and muscle pain from the gym. Detoxifies the Body Everyone wants to find the next detox craze to put their body in a cleaning state. Instead of drinking lemon juice for days, try adding ashwagandha supplements to your body. Studies show that ashwagandha increases detoxifying enzymes that help clean out organs and reset functionality. This benefit can become particularly powerful for recovering alcoholics with liver damage. Furthermore, the root can protect against heavy metal toxicity, a widespread threat from processed foods and other products. Regulates Menstrual Cycles Irregular menstrual cycles, cramps, and heavy flows can cause discomfort at work, school, or daily life. Thus, many women want to keep their menstrual cycles under control. While birth control offers many positive benefits for women, ashwagandha is a natural approach that can positively impact menstrual regulation. The root can reduce menstrual cramps' pain, duration, and discomfort. Furthermore, it can help prevent uterine cancer. Aids Cancer Patients Studies show that ashwagandha might help combat cancer cells' growth and multiplication. In one study, the natural supplement inhibited cancer cell growth in breast cancer patients. The goal of cancer therapy is to reduce cancer cell growth while simultaneously eliminating existing cancer cells. With its corollary effects of improving chemotherapy and radiation treatment experiences, cancer patients may benefit significantly from this natural substance. Improves Memory The impacts of ashwagandha on working memory continually reveal themselves study after study. In one study that used the KSM-66 variety of the root, participants experienced significant memory and cognitive improvements on the Wechsl memory scale. Whether you’re a forgetful person or at risk for dementia or Alzheimer’s, adding ashwagandha to your daily supplements may offer significant benefits. Increase Testosterone Levels for Men Ashwagandha increases testosterone levels for men of many ages. Health experts link increased testosterone to improvements in muscle growth, bone density, heart health, and sexual vitality. Especially for elderly patients with decreasing testosterone levels, adding ashwagandha could have extremely positive impacts. Improves Sleep Quality and Relaxation Sleep remains one of the most important things for our health. However, many people struggle to get to sleep or stay asleep. These people usually deal with more daytime fatigue, concentration issues, and other problems. Ashwagandha can help improve the onset and efficacy of sleep. Significant improvements to this part of your health can have comprehensive benefits. Eases Symptoms of Perimenopause The onset of menopause impacts every woman differently. However, across the board, it usually causes emotional and energy changes that distress many females entering this phase. Ashwagandha can help reduce the irritation and tension of the perimenopause phase. With its comprehensive benefits for mood, sleep, relaxation, and inflammation, women taking this supplement might have an easier experience during menopause. Maximizes Your 'Healthspan' We often talk about lifespan in terms of how long people live, but I would argue what is more relevant is the quality of life and level of health you're able to maintain throughout that lifespan. You'll often hear this term referred to as your 'healthspan'. With its many positive impacts, taking ashwagandha may contribute to a maximized healthspan. People who integrate this supplement into their diet receive positive holistic benefits and can live to their fullest potential. Older people struggle with declining health from various hormonal shifts and other issues. Taking a supplement to combat these changes can significantly improve one’s later years. Ashwagandha provides excellent aid for elderly health outcomes. DISCLAIMER: Prior to using Ashwagandha, it is highly recommended to consult with a naturopathic doctor first. If you have diabetes, are pregnant, intend to become pregnant, are nursing, have low or high blood pressure, stomach ulcers, autoimmune diseases, or recently had or are getting ready to have surgery, only take Ashwagandha under the supervision of a naturopath or healthcare doctor. Allergies to Ashwagandha may develop for those with nightshade vegetable allergies. For additional information about Ashwagandha and other naturopathic medicinal treatments and services, please feel free to contact Dr. Courtney Holmberg, ND at 647-351-7282 to schedule an appointment today!

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. Still, 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 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.

We typically don't give much thought to our gall bladder when we think about digestion or hormones for that matter. While critical to more than just digesting fats, the importance of this tiny organ sitting tucked below our liver is often overlooked. Unless you’ve had gallstones or experienced some form of gallbladder disease, you might not even be aware of its function. ​ While originally thought to be a disorder brought on later in life by obesity and a high saturated fat diet, I’m seeing more and more young, thin and otherwise healthy women in my practice with disease of the gall bladder; from sludge to stones, to full cholecystectomy (removal) by the time they’re 30. This presents questions surrounding the variables causing gall disease and brings us back to their relationship to hormones. ​What is the gallbladder, and what does it do? The liver produces the bile that helps you digest fats, and the gallbladder stores it until it's required for digestion. Because it’s been stored, the bile in your gallbladder is more concentrated than the bile secreted by the liver. Symptoms of gallbladder dysfunction often include: Sudden onset pain just underneath your right ribcage, in your abdomen, occasionally associated with heartburn, nausea, gas, and fullness Pain between your shoulder blades A chronic ache in your abdomen that intensifies after eating complete blockages will result in pale, greasy, floating stools, and dark amber colored urine While it is thought that most of us will develop gallstones at some point in our lives, many of us won’t notice that we have them until we experience intense pain, usually after a rich meal high in fat. But stones are not the other concern. Cholestasis, also known as ‘biliary sludge’, is characterized by a reduced flow of bile into the duodenum from the gall bladder and/or liver, resulting in thicker, more concentrated bile. This increases the chances of stones, biliary colic, and acute pancreatitis. So where do hormones come into play? Well, like any other organ in our body, the gall bladder relies on hormones to regulate its physiological functioning. It is most notably influenced the following hormones: Melatonin, aka our sleep hormone. It regulates our biological clock in response to darkness. It helps prevent gallstones by reducing cholesterol levels in the bile, and by improving the conversion of cholesterol into bile salts (1). Furthermore, studies also show melatonin aids gallbladder contraction by strengthening the neuromuscular junction of the gallbladder walls and may make for a great therapeutic intervention to aid in the recovery of gallbladder attacks. Thyroxine, aka the inactive thyroid hormone. According to a 2016 study, women with thyroid disorders also notably have a higher incidence of gallbladder issues (1). This is because low, or suboptimal, levels of thyroxine (T4) are related to under-functioning bile acid flow and the loss of its resultant effects on the gallbladder. If bile output is compromised, so is lipid absorption and metabolism, leading to a higher likelihood of stone formation in the gland. Estrogen and Progesterone, aka female sex steroid hormones. We know pregnancy, oral contraceptives, and hormone replacement therapy all contribute to the formation of gallstones. This is because estrogen and progesterone lead to slower emptying and increased cholesterol to bile ratio in the gland, leading to supersaturation of bile and more sludge. What’s often overlooked (in my opinion) is bile’s influence on hormone metabolism. Bile is an important component in the elimination of estrogen and its metabolites through the liver, so sluggish function (or even worse, no gallbladder at all) often leads to sluggish hormone elimination and resultant hormone symptoms. This may attribute to high estrogen symptoms like cramping, breast tenderness, water retention, and acne. Cortisol, the stress hormone. When the brain sends stress stimuli down to the adrenal glands, cortisol is produced. Cortisol causes the liver to release glucose. It does this in order to provide energy for the body’s increased needs during stress or in cases of hypoglycemia. Interestingly, evidence shows that blockages in bile flow are also associated with states of dysfunctional communication between the hypothalamus, pituitary, and adrenals (all responsible for and influenced by cortisol)(2) What other variables contribute to gallbladder dysfunction? Eating less often throughout the day can actually lead to gallstones. Since the gallbladder stores bile during fasting states, it becomes super concentrated — along with the cholesterol contained in bile. Gallstones are generally crystallized bits of cholesterol. By eating more frequently throughout the day, your gallbladder has to secrete bile to help digest your food — and flush out stored cholesterol. Rapid weight loss can lead to gallstones, too. While it may be tempting to quickly shed winter pounds, if you want to avoid developing gallstones — or exacerbating the symptoms of an existing gallbladder disorder — try to stick to losing one-to-two pounds a week. Women are more likely than men to develop gallbladder disease or gallstones. Pregnancy, birth control pills, and the natural fluctuations of the menstrual cycle can cause a slowing down of the contractions of the gallbladder, causing bile to sit longer than normal. If you’re currently on hormonal birth control and are experiencing pain, indigestion, burping, gas, nausea, and/or bloating, discuss with your doctor or naturopath if these symptoms may be a result of your contraception method. Maintaining Gallbladder Health A heart-healthy diet is a gallbladder-healthy diet. If you have been diagnosed with gallbladder disease, or gallstones, or just want to minimize your risk of developing gallbladder disease, sticking to a diet that is low in saturated fats and high in mono and polyunsaturated fats is the way to go. Heart-healthy nuts like almonds, brazil nuts, or cashews Avocados Fatty fish like salmon, tuna, or sardines (small spaced out servings, since fish can still be fatty) Flaxseeds Fresh fruits and vegetables Foods rich in fiber, like broccoli, lentils, and legumes If you’re on hormonal contraceptives or hormone replacements therapy, you may want to discuss alternatives. There is some evidence that your coffee habit may help prevent gallstones. Skip the dairy creamers, if you want to keep your coffee gallbladder-friendly, and opt for almond milk instead. If you suspect you might have gallbladder dysfunction, you should visit your MD or ND. You’ll likely need some blood work and imaging. Gallstones can usually be detected on an ultrasound, but other disorders such as biliary dyskinesia (a motility disorder where the gallbladder does not eject bile properly) or cholecystitis (inflammation of the gallbladder) may require additional testing. For more information about maintaining your gallbladder and digestive health, or to discuss its potential influence on your hormones, please contact your Toronto Naturopathic Doctor, Dr. Courtney Holmberg, ND at 647-351-7282 to schedule an appointment today! References: Mohammadi-Sartang, Mohsen, Mohammad Ghorbani, and ZohrehMazloom. “Effects of melatonin supplementation on blood lipid concentrations: A systematic review and meta-analysis of randomized controlled trials.” Clinical nutrition 37.6 (2018): 1943-1954. Swain MG, Patchev V, Vergalla J, Chrousos G, Jones EA. Suppression of hypothalamic-pituitary-adrenal axis responsiveness to stress in a rat model of acute cholestasis. J Clin Invest. (1993) 91:1903–8.

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

It probably comes as no surprise that a gluten-free diet has become one of the most popular food trends of this decade. Originally deemed inflammatory to the small intestine of celiac patients, gluten intolerance has since been correlated to a number of other medical conditions such as irritable bowel syndrome, anxiety, dermatitis, autoimmune disorders, and so on. Grocery stores now dedicate a whole section to gluten-free products and foods, creating many alternatives that mimic the wheat-based staples of the North American diet. And while these products are helpful for individuals with allergies or intolerances to gluten, a considerable number without these diseases still adopt a gluten-free lifestyle in hopes of reaping some health benefits. ​But there's one major mistake many people are making. Gluten is a grain protein found in wheat, spelt, barley, and rye. Its also added as a filler to many dressings and sauces, such as soya sauce. Individuals with intolerances to gluten may experience a number of symptoms, including but not limited to gas, bloating, diarrhea/constipation, joint pain and/or swelling, fatigue, brain fog, mood issues such as anxiety or depression, headaches, mouth ulcers, and dermatitis herpetiformis (unique to celiac disease). And while gluten intolerances exist, the list of associated symptoms is very broad and non-specific, meaning the same symptoms can also be seen in a number of other medical conditions such as food intolerances, anemias, dysbiosis, hypochlorhydria, and so on. It's always best to talk to your Naturopath or Family Doctor before deciding to sustain a gluten-free diet. The most important fact I want to highlight here is this... A product labelled "gluten-free" does NOT mean it's a healthier alternative. Now let me be clear... following a gluten-free lifestyle lays some important groundwork for a less refined, more whole foods, and overall healthier diet. However, the mistake is made when, instead of limiting refined foods like bread, crackers, and pasta altogether, people reach for their gluten-free alternatives. To shed evidence on the situation, new and interesting research coming out of Harvard University found after reviewing 30 years worth of medical data that individuals limiting or completely avoiding gluten had a 13% increased risk of type 2 diabetes [1]. Now does that mean gluten prevents diabetes? Unlikely. But what it does suggest is that gluten-free foods often contain less fibre and other macronutrients helpful in preventing metabolic disorders. Secondly, the most common ingredients found in gluten-free alternative products are rice and corn. Most of the corn in these kinds of pasta is genetically modified, and because corn flour doesn't stay together as well as wheat, a number of chemical binding agents get added to the mix to create a wheat-like texture. A cup of brown rice pasta has a glycemic index (GI) of 92 and a glycemic load (GL) of 52 !!! (I call it diabetes in a box), vs a cup of whole wheat pasta with a GI of 37 and a GL of 17 [2]. Also, if you didn't know, rice is loaded with arsenic, with brown rice being the highest source of it. Without going into too much detail on this topic, I'll direct you to the Environmental Working Group's website, which has a great resource here highlighting the problems with arsenic, how it's getting into our rice and ways to limit/avoid it [3]. So yes, this Naturopath enjoys the occasional slice of toasted whole grain bread with brunch and the occasional hoppy brewed beverage on a summer patio. I'm fortunate to not experience a gluten intolerance, which means I don't limit it completely, but I also don't consume it often. My diet tends to limit refined carbohydrates in general, gluten and gluten-free all the same. Remember, the foods that were always gluten-free (ie popcorn) are now re-branding with gluten-free labels in hopes of catching a few more consumers who are getting in on the action. We must act as educated consumers, or else it becomes very easy to fall victim to the next biggest health trend and miss the mark completely. The moral of the story is if you're going gluten-free, part ways with refined carbohydrates instead of reaching for the chemically altered, less nutritious gluten-free substitutes. And for goodness' sake, eat your veggies. [1] Low gluten diets may be associated with a higher risk of type 2 diabetes. American Heart Association Meeting Report Presentation 11. March 09, 2017. ​http://newsroom.heart.org/news/low-gluten-diets-may-be-associated-with-higher-risk-of-type-2-diabetes?preview=076d [2] The University of Sydney Glycemic Index Database. http://www.glycemicindex.com/www.ewg.org/foodscores/content/arsenic-contamination-in-rice [3] Arsenic is in rice - should you worry? Environmental Working Group Food Database. http://www.ewg.org/foodscores/content/arsenic-contamination-in-rice

Whether or not you're new to the coconut oil craze, or you've been soaking your skin with it for years, there is no doubt you've made the right choice by hopping onboard. Despite the fact that this natural, drupe-based oil received unwarranted flak for a number of years for being a saturated fat, the jury is out... and we were wrong. And although it lacks a few extra double bonds, this oil has many - if not more - health benefits than a number of the other unsaturated vegetable oils that sit in most pantries today. But the best part… theres evidence to prove it. So without further ado, heres why… first things first… a lesson on fatty acids Generally speaking, fatty acids are long molecules found in both vegetable and animal products that are used by the body to create lubrication for our joints, insulation for our nerves, protective cushioning for our organs, and ultimately make up the outer membrane of every single cell in our body. By now, I'm sure you've begun to appreciate their importance. The key to remember about any fat is the types, quantities, and lengths of the fatty acids it contains. To explain, there are both saturated fatty acids (SFA), which lack double bonds (like coconut oil) and are therefore solid at room temperature, and unsaturated fatty acids, which contain double bonds (like our omega oils) and are liquid at room temperature. For a long time, if was believed that saturated fats were bad for our health, but that myth is debunked below. In the food industry, there exists a third form known as hydrogenated fatty acids, which basically means the unsaturated fat has been given a few extra hydrogen atoms to make it more stable at room temperature. However, in doing so, the break down of this product creates trans fats, which are not found in nature and are unrecognizable to our bodies, therefore ending up places they shouldn't - like the walls of our arteries. the myth about saturated fat A meta-analysis done by the American Journal of Clinical Nutrition concluded that we've had it wrong for years - saturated fats are evidently harmless, and there is "no significant evidence that dietary saturated fat is associated with increased risk of Coronary Heart Disease or Cardiovascular Disease". Furthermore, another study from the AJCN showed that replacing SFA with unsaturated fatty acids had no effect on the fluidity or stiffness of arterial walls. Now this doesn't mean that everyone at risk for heart disease should go liberally divulging on animals fats and cheese, as there is an importance to the type of saturated fat consumed, and of course in moderation. That importance is in it's length. Coconut oil is set apart from other fatty acids because it is made up predominantly (~70%) of medium-chain fatty acids, which are absorbed directly into the digestive tract and sent straight to the liver, and unlike animal and dairy products, they do not require bile salts for breakdown. Coconut oil is therefore a direct source of energy - remember this for later. To top it all off, a saturated fat like coconut oil tolerates high temperatures much better than most unsaturated fats like corn, sunflower, or olive oil, and that is due to it's higher smoke point. The smoke point of an oil is the temperature at which the oil begins to break apart, producing byproducts and free radicals that can be dangerous to the body. Most unrefined oils on the shelves (depending on their quality) have a smoke point ranging from 250 - 320°F, whereas coconut oil ranges upwards of 350°F. Therefore, the use of coconut oil decreases the risk of free radical damage from cooking. why we should all ditch the carbs for fat While every cell in the body burns glucose (the breakdown product of all carbohydrates), the heart and skeletal muscle in particular prefer fatty acids, as it is a greater source of energy production, and doesn't require insulin to do so. This point is very important, as so much of the population today experiences insulin resistance (the first step to type II diabetes) due to the overburden of insulin our body experiences from all the sugar we consume. FUN FACT: 4 g of sugar on a food label = 1 tsp of white sugar… think about it next time you read the side of a box. Moreover, the foods we eat and the sources they come from have effects on the way in which our body handles our hormones. Firstly, high amounts of sugar increases insulin, which counters cortisol, leading to more fat storage in the abdomen and less breakdown. Now for the importance of those medium-chain fatty acids I mentioned. One study shows that the thermic effects of medium-chain fatty acids in coconut oil are greater than long-chain fatty acids of equal calorie content, suggesting an important take home message: a calorie is not a calorie. There isfurther evidence to suggest that increasing medium-chain fatty acids in the diet can increase your body's energy expenditure by 5%, which averages an extra 120 calories burnt per day. The ketone bodies that are produced from coconut oil's metabolism is also shown to have appetite reducing effects, meaning less calories consumed throughout the day. So yes, it is too good to be true … sugar = fat storage, and fat = weight loss. other fabulous facts about coconut oil FOR YOUR SKIN and HAIR: it has an SPF of 10 (blocking ~20% of the suns rays), making it not only incredibly hydrating to the skin and hair, but protective. Furthermore, coconut oil is made up of ~ 60% lauric acid, a natural antiviral, antibacterial, and antifungal, making it a great topical treatment for infected wounds or fungal infections like tinea. Don't forget, it works the same way internally, for preventing things like candida. FOR YOUR BRAIN: we all know fatty acids are essential for brain function and development, but medium-chain fatty acids specifically are turned into ketones by the body, which some studies have shown to have therapeutic effects in conditions such as epilepsy and Alzheimer's. Something to consider... FOR YOUR CHOLESTEROL: studies show coconut oil increases levels of HDL (the "good" cholesterol) and lowers oxidative damage of LDL (the type that clogs our arteries when exposed to oxidative damage). FOR YOUR DIGESTION: because it requires no energy for breakdown or transportation across the intestines, people who suffer from IBS or Crohn's may benefit from the ease of coconut oil's absorption. More remarkably, those who suffer from gallstones or bile duct conditions will not be affects by coconut oil, as this fat requires no bile salts for emulsification. Hooray! FOR YOUR HEALTH: fat soluble substances, like vitamin A, D, E, and K, and minerals like calcium are all more readably absorbed when taken with coconut oil. Your mood, your bones, and your immune system will love you for it. REMEMBER: like any oil, coconut oil varies in quality. When choosing a brand, go for UNREFINED and VIRGIN forms (meanly those lovely medium-chain fatty acids haven't been destroyed in the making). My favourite so far - Carrington Farm's cold-pressed, organic coconut oil, found at Costco for a fantastic price (~17$ for a tub that will last you months).

Unless you've been living under a rock, I'm sure you've come across the ingredient every product is labelling free of and every consumer is trying to avoid gluten. One of the most common questions I'm asked with regard to dietary changes in practice is "should I be gluten-free too?" Stats say roughly 29% of households now have a family member who eats gluten-free, and the "Gluten Free" label has become the top 5th label claim since 2011. But when asked, less than a third of respondents (including those who claimed to be gluten-free) actually knew what gluten was and where it was found. So... what is it? Why is it bad for us? And what's with all the hype anyways? There are a number of articles circling the web on either side of the gluten fence. I'm not here to persuade you but to inform you, so listen closely. First off... what is gluten? Gluten, by definition, is a family of proteins, made up of gliadin and glutenin that give bread its elasticity, or ability to rise. The family that seems to be problematic in today's diet is found in wheat, barley and rye. Dr. Tom O'Bryan, a certified gluten practitioner in the US, discusses the reason for its "toxicity". He states that although not everyone may show symptoms of sickness from eating gluten, the human body does not produce intestinal enzymes to break down the gliadin component of the protein [1]. For someone with celiac disease, this is a serious problem. Their immune system produces an anaphylactic response when exposed to the gluten protein (even in minute amounts)... much like someone would with a bee allergy, but in their gut. These people often carry a gene that predisposes them to this condition, and a gluten-free diet is absolutely essential for them. The interesting fact is that there has been a 4 fold (or 400x) increase in the incidence of celiac disease over the past 50 years [1]. That leaves us with the question... Why is gluten suddenly a problem? Although wheat hasn't changed, and has been cultivated now for roughly 10000 years, its been only in the last 500 years that the actual content of gluten in wheat-based foods has gone up [2]. This is because gluten helps breads rise and holds food together, making for better texture, and is therefore actually added to foods already containing gluten. It can also be found in cosmetics, hair products, and household cleaners. It's important to note that although only 3% of those with the celiac gene actually develop celiac disease, roughly 30% of the population carries the gene. So why isn't everyone developing celiac? Tom O'Bryan states this is due to the concept of loss of oral tolerance - meaning overexposure and weakened gut health due to environmental factors may be the key to the expression of this gene [3] Can we test for it? The short response would be yes. Without boring you with the details, blood samples can test for antibodies to the gluten components to see if your body is mounting an immune response to them, but the gold-standard testing for diagnosing celiac disease is an intestinal biopsy, looking for destruction of the brush border, or "microvilli" of the gut lining. HOWEVER... it's very important to understand that lab testing is not the gavel of medicine. Clinical symptoms are just as, if not more important, than lab values. Now, science says these tests are very accurate at determining celiac disease - but only in those with full-blown villous atrophy, or complete destruction of the brush border. If the lab tests included all stages of symptoms, the stats drop to roughly 27-32% efficacy [4.5]. This means that, in this case in particular, the testing is really only conclusive for those with COMPLETE microvilli destruction, not partial or moderate states. Therefore, although people are symptomatic, they're experiencing false negatives with testing, and are deemed "non-celiac". This leads us to the topic causing the most controversy... Non-Celiac Gluten Insensitivity Have I lost you yet? So you've tested negative for celiac disease. Or in some cases, your blood tests are positive, but the biopsy is negative (for further info on this, check out this article). But you're experiencing symptoms. How can this be explained? A condition called "NON-CELIAC GLUTEN SENSITIVITY", or NCGS - is a condition that the medical community is slowly including as a clinical diagnosis. Basically, your biopsy does meet the criteria for celiac disease, but you're still mounting an immune response to gluten. While it's still largely misunderstood, there's research that attributes this phenomenon to "leaky gut syndrome", which is basically inflammation in the gut that develops from the environmental exposures that allow substances to pass between the cells instead of through. So now your immune system is reacting to the gluten you're intaking in a systemic inflammatory way, much like you're body would react to a bacteria or virus coming through the gut. This inflammation is not localized to the gut, as these antibodies cycle through your body, causing a number of indirect symptoms. such as bloating and gas, joint pain, skin conditions, mental fog/depression, fatigue, etc. This is where we see cross-linking between other immune conditions, such as Hashimoto's Thyroiditis (hypothyroidism), Inflammatory bowel disease, Systemic Lupus, Inflammatory skin conditions, etc. Some of the symptoms: the Journal of Attention Disorder (2004) published a study showing people with ADHD also reported the following list of symptoms, all of which improved with a gluten-free diet: 87% bloating 83% abdominal pain 31% sores in the mouth 68% lack of wellbeing 64% fatigue 54% headache 39% anxiety 31% joint or mm pain So is a gluten-free diet healthier? Again, the short response would be maybe. IF DONE PROPERLY. Since gluten-free has become so widely recognized as a healthier way of eating, many food companies have followed the trend of creating gluten-free alternatives. Now, just because something is labelled "gluten-free" does not mean this alternative is healthier for you - most cereals, bread, and snack foods are loaded with high fructose corn syrup to make up for the loss of gluten, which comes with a whole new bag of problems. What can I do? 1. eat NATURALLY gluten-free items If you've chosen to avoid gluten, also choose to avoid the alternatives. Corn and rice-based products are gluten-free but skip on the bread, cereal, and snack alternatives. Choose whole foods, increase produce and protein (grass-fed as opposed to grain), and up your omega 3s (flax, walnuts, fish, etc) to offset the more inflammatory omega 6s that come from grains. Choose items such as quinoa, rice, millet, or buckwheat for your grains. Cook with almond or coconut flour. Search the web for gluten-free blogs (they're everywhere). If you've got to have your bread fixed, find a great local gluten-free bakery you can trust. 2. do some further reading There is so much on this topic that I haven't even touched on. There's research on the theory that gluten sensitivity is correlated to Alzheimer's and Dementia, as well as a number of other neurological conditions. Although quite opinionated, these books are user-friendly resources to find out more: - The Grain Brain, David Perlmutter, MD - The Wheat Belly, Dr. William Davis, MD 3. address your gut Leaky gut syndrome is a consequence of lifestyle and environment. Many things cause inflammation in our enterocytes, leading to food allergies and systemic symptoms. Your naturopath can run a food allergy test, or IgG test to find out if you're having an immune-mediated response to any of the foods you're consuming - not just gluten. Learn more about FOOD ALLERGY TESTING HERE >> Furthermore, if any of these symptoms sound like something you're experiencing, see if naturopathy can help by booking your naturopathic consult HERE >> References: Celiac Disease on the Rise. Mayo Clinic: http://www.mayo.edu/research/discoverys-edge/celiac-disease-rise US perspective on gluten related disease. Clinical and Experimental Gastroenterology. http://cdn.thedr.com/wp-content/uploads/2014/11/US-perspective-on-gluten-related-diseases-Leonard-2014.pdf Meresse B., , Ripoche J., Heyman M., Cerf-Bensussan N., Celiac disease: from oral tolerance to intestinal inflammation, autoimmunity and lymphomagenesis, Nature Vol 2 No 1, JANUARY 2009 Abrams JA, Diamond B, Rotterdam H, Green PH. Seronegative celiac disease: increased prevalence with lesser degrees of villous atrophy, Dig Dis Sci. 2004 Apr;49(4):546-50 Tursi A., Seronegative Coeliac Disease: a Clinical Challenge. BMJ 26 April, 2005.

Our skin provides us with a wonderful reflection of what’s occurring below its surface. Contrary to popular belief, acne is not a result of improper facial hygiene. It typically presents itself as the unfortunate indicator that there's an internal problem. And while most reach for the latest and greatest topical products that promise results, many forget to ask the important question of "why is this happening in the first place?" The root of acne formation is centred on the oil gland, known as the sebaceous gland. Hormonal changes, inflammatory foods, disrupted skin pH, etc. can lead to changes in the quality and amount of sebum produced, creating low-level inflammation. This inflammation can plug the follicle, creating little papule-like lesions called closed comedones. Bacteria see these comedones as honeymoon destinations, and the more overgrown with bacteria these blocked follicles become, the larger and more cystic the resulting "pimple". If the cyst ruptures below the dermis, the lesions last a lot longer and are more likely to trigger scarring. So how do we manage it? Since lesions are most commonly the result of oxidative damage and hormonal imbalances, the trick is to work from the inside out. HORMONES First and foremost, we must investigate hormones. Higher levels of dihydrotestosterone are attributed to increased sebaceous gland activity and acne formation. This is common in conditions like PCOS and congenital adrenal hyperplasia, with associated symptoms of irregular or infrequent menses, the middle-age onset of acne, male-patterned hair growth around the chin/nipples/stomach/hands, and insulin resistance. However, not all of these symptoms have to be present for hormones to be disrupted, making it difficult to uncover the underlying problem. Hormone testing can be a useful tool in these cases Speak to your ND about completing a thorough hormonal assessment Furthermore, evaluate your birth control pill. Certain birth control pills have higher androgen activity than others, resulting in a higher likelihood to worsen acne. While birth control is never my suggested treatment of choice for acne, if you choose to use it, ensure it's an appropriate combination. THE LIVER While balancing hormones in the body is important, the elimination of these hormones is just as critical. Your liver acts as a filter, eliminating degraded hormones and preventing hormonal congestion that results in acne. Alcohol, birth control, environmental toxins, etc all burden our liver on a daily basis, leading to sluggish detoxification and toxins being shifted to our major detox organ, the skin. Try: lemon water in the morning, dandelion root tea, 2-3 L of water daily (depending on body weight), alcohol-free for 6 wks DIET A high intake of refined carbohydrates, sugars, and preservatives results in blood sugar spiking, and subsequent boosts in insulin levels. High levels of insulin in the bloodstream trigger sebum production and an increase in pore-clogging cells. Dairy also tends to be a problematic food, as it's rich in IGF-1, which also promotes insulin release. An imbalanced, high-carb diet may be attributed to you producing all the wrong hormones as an older adolescent or adult. Try: a low GI diet, removing dairy for 6-8 wks, having your insulin resistance measured DIGESTION Just as the liver detoxifies hormones, the colon actually excretes them. If bowel movements are not regular, degraded hormones sit in the gut waiting to be reactivated and resorbed by "bad" bacteria. Furthermore, consuming foods you may be sensitive to (ie food intolerances) results in higher levels of overall inflammation in the diet every time you eat them. Try: lactobacillus acidophilus probiotics, increasing intake of naturally fermented foods like kombucha or sauerkraut Consider: Food Sensitivity Testing ​ NUTRIENTS Certain minerals and vitamins have been shown to be effective treatments for acne-prone skin. Zinc-containing foods, like pumpkin seeds, lamb, chicken, kefir etc, are encouraged for those with acne, as a recent study published in BioMed Research International identified a correlation between low zinc levels and the severity of acne. Furthermore, B6, B5 and Vitamin A all have balancing effects on skin pH and sebum production. Always remember, vitamins and nutrients at the therapeutic dosages required to treat certain conditions can have severe risks and side effects. Never self-prescribe; always speak to a licensed professional. TOPICALS Last but not least, what you put on your skin is important. If you’ve been using strong washes or cream moisturizers, STOP now. Harsh chemicals in washes that come over the counter or prescription grade strip the natural pH of the skin, leading to higher amounts of oil production to recent the balance. Furthermore, creams are glycerin based, which the skin does not properly absorb. Instead, it sits on the surface of the skin, trapping debris and oil within the pores, and preventing the skin from breathing. That sounds like a recipe for acne to me. Try gentle foaming cleansers without sulphates and benzoyls, and serum moisturizers that are glycerin-free (light carrier oils are important). As always, feel free to contact me should you have any questions regarding testing and/or treatments. References: 1. Leyden JJ. Therapy for acne vulgaris. N Engl J Med 1997; 336(16):1156-62. 2. Pantothenic Acid, Vitamin B5 for Acne by Jeffrey Dach MD. http://www.drdach.com/Acne_B5.html 3. Rostami Mogaddam M, Safavi Ardabili N, Maleki N, Soflaee M. Correlation between the severity and type of acne lesions with serum zinc levels in patients with acne vulgaris. Biomed Res Int. 2014;2014:474108

Magnesium is the 4th most abundant mineral in the human body. It is found in every cell in the body and is an essential component in regulating over 600 different biochemical reactions and bodily functions. It helps convert food into energy, build new proteins, repair DNA/RNA, regulate muscle relaxation, and balance neurotransmitters in the brain, nervous system, and gut. It has direct impacts on heart health, blood pressure, immune response, metabolic rates, and more. ​ Unfortunately, magnesium deficiency is on the rise, with an estimated 50% of the population in the US and Europe getting less than their daily requirement of magnesium (1). Historically, magnesium was abundant in the foods we ate and the water we drank. However, today, most soil-grown produce has been shown to be more magnesium depleted than ever, and even the grass and grains livestock eats lacks magnesium content. For those of us that live in the city, our water is treated with chlorine and fluoride to remove bacteria and minerals, like magnesium. Furthermore, the consumption of caffeine, sugar, alcohol, and medications like birth control pills, antihypertensives, insulin, and certain antibiotics all deplete magnesium further. One particularly important mechanism magnesium regulates is our balance and utilization of calcium. Every cell has a regulatory switch that controls the balance between calcium and magnesium, and when there is a deficiency in magnesium, the switch will allow excess calcium into the cells. This can ultimately lead to cellular calcification, amongst a number of other concerns, including: Muscle Cramps and Spasms – Calcium is essential for muscle contraction, whereas magnesium allows muscular fibres to unbind, and ultimately relax. As a result, low levels of magnesium may lead to muscle stiffness, cramping, and spasms. Calcification of the Arteries – Magnesium deficiencies increase the risks of calcification in the arteries as a result of unopposed calcium in the bloodstream. Atherosclerosis and arteriosclerosis are primary warning signs. Hypertension (High Blood Pressure) – Calcification can cause blood pressure rates to become higher. A Harvard study showed that those with the highest magnesium intake had the healthiest blood pressure levels. Fatigue/Lack of Energy – All of our cells contain adenosine triphosphate (ATP), a chemical that must bind with magnesium in order to convert itself into energy. With low magnesium levels, our energy molecules remain unusable, and as a result, our energy level often declines. Problems Sleeping – Magnesium promotes active muscle relaxation, and is essential for the proper function of our GABA receptors. When activated, GABA promotes restful relaxation, improving not only our ability to fall asleep but maintain sleep. Furthermore, Hormone Imbalances – There is a direct correlation between estrogen/progesterone and magnesium levels in women. The higher the hormones – the lower the magnesium. Additionally, increased hormone levels during pregnancy can quickly deplete magnesium levels. Low magnesium levels can make menstrual cycle cramping more severe. Pregnancy Health Complaints – Pregnant women tend to have more cramping, pregnancy-related high blood pressure, and other such problems, all signs of low magnesium levels. Depression and Anxiety – Chemical imbalances in the brain brought on by stress and anxiety could be contributed to magnesium deficiency, as well as certain types of depression. Furthermore, as mentioned above, magnesium’s relationship to GABA receptors means that lower levels result in a less relaxed state of mind. Deficiencies in Other Minerals – Without the right level of magnesium in the cells, other minerals, such as calcium, potassium, vitamin K and vitamin D, are not utilized correctly. Bone Density Concerns – In order for Vitamin D to be able to help absorb calcium into the bones, where it belongs, it needs the right amount of magnesium. Magnesium also works with a hormone called calcitonin that draws calcium out of the muscles, circulatory system, and soft tissues so it can be absorbed by the bones. With the proper magnesium levels in the body, risks for heart disease, heart attack, kidney stones, calcification in the arteries, and osteoporosis are reduced. To ensure proper magnesium levels, expose yourself to these magnesium-rich foods: Spinach and Chard: ~ 157 mg/cup Pumpkin Seeds: ~ 92 mg/1/8 cup Almonds: ~ 80 mg/1 cup Black Beans: ~ 60 mg/ ½ cup Avocado: ~ 60 mg/1 medium Dark Chocolate: ~ 95 mg/1 square (did you know specific chocolate cravings are suspected to be a sign of a Mg deficiency!) Bananas: ~ 30 mg/1 medium If you have experienced any of the signs discussed, and want to find out more about the benefits of magnesium, please feel free to contact Toronto Naturopathic Doctor, Dr. Courtney Holmberg at 647-351-7282 to schedule a consultation today! Rosanoff A1, Weaver CM, Rude RK. Nutr Rev. Suboptimal magnesium status in the United States: are the health consequences underestimated? 2012 Mar; 70(3):153-64. Elin RJ, Rude RK. Oral magnesium and wellness. The Magnesium Report: Clinical, Research and Laboratory News for Cardiologists. 2000. Fox C, Ramsoomair D, Carter C. Magnesium: its proven and potential clinical significance. Southern Medical Journal. 2003;94(12):1195-201. Kimura M. Overview of Magnesium Nutrition. In: International Magnesium Symposium. New Perspectives in Magnesium Research. London: Springer-Verlag; 2007:239-260. Pumpkin Seed Nutritional Profile: superfoodprofiles.com/raw-pumpkin-seeds-nutrition

The Ketogenic diet is an extremely popular diet amongst the weight loss community. Originally brought to light for its promising research in epilepsy management, it quickly became a hopeful solution for those looking to quickly shed pounds without massive caloric restrictions. But like any trend, we must weigh all the pros and cons, while simultaneously accounting for the long-term impacts on our health. First off, let's break down what the ketogenic diet actually involves. The premise of the diet focuses on reducing carbohydrates to force the body into an anabolic (breakdown) state, known as ketogenesis. Ketogenesis is a metabolic process our bodies enter into when sources of glucose (both dietary and stored) cannot keep us with metabolic needs, forcing the body to produce ketone bodies from adipose tissue (aka fat) to use for energy in place of sugar. As you can imagine, this is favourable for weight loss for several reasons. In addition to fat now being used as fuel, the blood sugar staying so low sharply drops insulin secretion, which further reduces the stimulus for fat and sugar storage. As long as the body remains deprived of carbohydrates, ketosis is sustained and weight loss continues. There’s also the concept of something called ‘super fuel’, meaning ketone bodies produce more usable ATP molecules (aka energy) to the heart, muscles, and brain than glucose, resulting in the additional energy and mental focus many people report while in ketosis.1 ​ Studies are showing very promising results for epilepsy, and have been well documented and proven to be effective for rapid weight loss, with initial weight loss of up to 10 lbs in 2 weeks or less.1 However, literature exceeding 2 years of use is lacking, and some studies raise show some red flags are raised within 3 months into ketosis that may have more concerning health implications long-term. Let’s dive further into what those risks are. #1: Vitamin and mineral deficiencies. While the ketogenic diet does help to eliminate certain unhealthy foods, like refined sugars and carbohydrates, it also eliminates fruits and other vegetables that contain carbs. It’s no surprise that fruits and vegetables provide a primary source of the vitamins and minerals the body needs for optimal health, in addition to being high in antioxidants. Now, there are also two ways to approach ketosis – one that maintains a high low-carb vegetable intake and a balanced amount of saturated fats, and one that involves eating bacon and hamburger patties at every meal. All that aside, Harvard health highlights the most common nutrients depleted on a ketogenic diet are electrolytes like sodium and potassium, magnesium, calcium and b vitamins.2 Supplementation is an option, but no concrete evidence shows supplementing vitamins and minerals provides the same health outcomes as getting them from nutritious food, so I always suggest food first. #2: Ketosis, digestive health, and the microbiome. Beyond constipation that comes from a lack of grains & fibre that result from a keto diet, the impacts of a long-term high fat/low carb diet on the microbiome are of my greatest concern. Without dietary fibre, people on the Keto diet can experience either diarrhea or constipation, as well as bloating. Sometimes these are transient side effects, and other times not. However, dietary fibre is the key ingredient to a microbiota-accessible carbohydrate (or MAC) diet. Fibre is what feeds our flora, which they then convert it short-chain fatty acids like butyrate that provide us with the endless health benefits we hear about surrounding probiotics. Without fibre, our flora suffers, which is demonstrated in the literature looking at all fibre-deficient diets, including FODMAP and gluten-free diets.3 Even short-term ketosis reveals a “statistically significant increase in Desulfovibrio spp, a bacterial group supposed to be involved in the exacerbation of the inflammatory condition of the gut mucosa-associated to the consumption of fats of animal origin”.4 To vastly oversimplify the research, it seems the benefits of the ketogenic diet on the microbiota as a whole are unclear. Some studies show a favourable increase in beneficial flora, while others show the opposite. In summary, the take-home seems to be that an overall decrease in microbial diversity is seen in those following a ketogenic diet.3 #3: The Keto diet can worsen athletic performance, and maybe even long-term weight loss Losing fat sounds great when you want to get fit. However, recent research found that in a ketogenic state, study participants performed worse on running and high-intensity cycling tasks after being on the Keto diet for four days, compared to participants that spent the same four days following a high-carb diet.5 The conclusion of the study suggests “short-term low-carbohydrate, ketogenic diets reduce exercise performance in activities that are heavily dependent on anaerobic energy systems. These findings have clear performance implications for athletes, especially for high-intensity, short-duration activities and sports”.5 Therefore, you may wish to again if you’re considering using the ketogenic diet to fuel your HIIT workouts every morning. Recent studies have also highlighted that “ketogenic diets impair glucose and lipid metabolism in mice” 6, suggesting that long-term use may actually alter metabolic activity. There may also be concerns around the “yo-yo” effects of the Keto diet (where people lose fat, only to gain it back, and oftentimes more) on long-term metabolism. #4: Following the Keto diet long-term can increase the risks of chronic diseases. Since fat consumption is essential to fueling ketogenesis, participants need to consume foods with high-fat content to maintain a ketogenic state. As a result, a rise in cardiovascular risk factors is often seen. Some literature shows an increase in blood pressure and cholesterol levels in ketogenic states, which is something I also see demonstrated in blood work for my current patients on a ketogenic diet. A study from the American College of Cardiology found that people following the Keto diet long-term had a higher risk of developing atrial fibrillation, a common heart rhythm disorder that also increases risks of heart disease and strokes.7 Other literature also highlights adverse effects including hepatic steatosis, hypoproteinemia, and kidney stones.1 In conclusion, it’s safe to say the use of a ketogenic diet needs to be evaluated on a case-by-case basis, and there calls for a collection of better long-term safety research before the diet can be considered as an ongoing intervention. With your microbiome always at the forefront of my mind, short-term ketosis may result in some favourable shifts in weight and metabolism, but offsetting the long-term impacts should be discussed with your ND. To find out more about the right dietary adjustments for your gut and metabolism, please feel free to contact Toronto naturopathic doctor, Dr. Courtney Homberg at 647-351-7282 to schedule your appointment today. Sources: Masood W, Annamaraju P, Uppaluri KR. Ketogenic Diet. [Updated 2020 Dec 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. https://www.health.harvard.edu/staying-healthy/should-you-try-the-keto-diet#:~:text=Other%20potential%20keto%20risks%20include,and%20C%2C%22%20McManus%20says. Reddel S, Putignani L, Del Chierico F. The Impact of Low-FODMAPs, Gluten-Free, and Ketogenic Diets on Gut Microbiota Modulation in Pathological Conditions. Nutrients. 2019;11(2):373. Published 2019 Feb 12. doi:10.3390/nu11020373 Tagliabue A, Ferraris C, Uggeri F, Trentani C, Bertoli S, de Giorgis V, Veggiotti P, Elli M. Short-term impact of a classical ketogenic diet on gut microbiota in GLUT1 Deficiency Syndrome: A 3-month prospective observational study. Clin Nutr ESPEN. 2017 Feb;17:33-37. doi: 10.1016/j.clnesp.2016.11.003. Epub 2016 Dec 18. PMID: 28361745. Wroble KA, Trott MN, Schweitzer GG, Rahman RS, Kelly PV, Weiss EP. Low-carbohydrate, ketogenic diet impairs anaerobic exercise performance in exercise-trained women and men: a randomized-sequence crossover trial. J Sports Med Phys Fitness 2019;59:600-7. DOI: 10.23736/S0022-4707.18.08318-4 Li Y, Yang X, Zhang J, Jiang T, Zhang Z, Wang Z, Gong M, Zhao L, Zhang C. Ketogenic Diets Induced Glucose Intolerance and Lipid Accumulation in Mice with Alterations in Gut Microbiota and Metabolites. mBio. 2021 Mar 30;12(2):e03601-20. doi: 10.1128/mBio.03601-20. PMID: 33785628; PMCID: PMC8092315. https://www.acc.org/about-acc/press-releases/2019/03/06/10/29/low-carb-diet-tied-to-common-heart-rhythm-disorder

PCOS (Polycystic Ovary Syndrome) is a hormonal disorder common in reproductive-age women. The exact cause of PCOs is not fully understood. Women with this condition may experience higher levels of androgen (male hormones), prolonged or infrequent menstrual periods, and problems in the ovaries. ​ When PCOS can be diagnosed earlier, and treatment can begin, risks of long-term complications could be reduced. PCOS can develop during the first menstrual period or later in life from a change in health, like becoming obese. Common Symptoms Associated with PCOS Some of the more common symptoms that could indicate a woman has developed PCOS include: Excessive levels of androgen. Having elevated levels of androgen can cause baldness, excess bodily and facial hair, and severe acne. Irregular menstrual cycles. If periods are irregular, prolonged, or infrequent, it could indicate PCOS. For instance, menstrual periods are abnormally heavy, occur more than 30-40 days apart, or occur less than nine times a year. Fluid buildup in the ovaries. If fluid retention is occurring in the ovaries, they can become enlarged and not release eggs regularly. Furthermore, ovaries can fail to function correctly. Becoming obese. Excessive weight gain can aggravate the symptoms associated with PCOS. ​ Side Effects of PCOS There are several side effects a woman may experience when she has PCOS, such as: Premature Births Miscarriages Infertility Type 2 Diabetes Metabolic Syndrome Sleep Apnea Eating Disorders Anxiety Depression Endometrial Cancer Abnormal Bleeding of the Uterine Nonalcoholic Steatohepatitis Gestational Diabetes High Blood Pressure during Pregnancy How Is PCOS Diagnosed? There are several different methods used to diagnose PCOS. Typically, your healthcare provider will inquire about your medical history, menstrual cycles, weight changes, and so on. Additionally, they may perform a pelvic exam, blood tests, and an ultrasound. A pelvic exam helps identify abnormalities in the ovaries. Blood tests can check insulin levels and levels of androgen. An ultrasound helps provide information about the appearance of the ovaries and reproductive system. How Is PCOS Treated? There are different treatment options for PCOS. Specific treatments will vary depending on the individual and the extent of their symptoms. However, lifestyle changes are very common. For example, if you are obese, your healthcare provider will prescribe treatment to lose excess weight, exercise more frequently, and eat a healthy diet while limiting carbohydrates. There are also medications to help regulate menstrual periods and increased levels of androgen. Ideally, treatment should focus on decreasing the effects of PCOS. It is important to remember that treatments can be ongoing to manage the condition. In some cases, you may be referred to a specialist to address specific issues and concerns, like infertility. If you suspect you might have PCOS, it is imperative to schedule an appointment with a healthcare provider as soon as possible. If you have further questions about PCOS, suspect you might have it, or want to know how to manage PCOS using holistic treatment methods, please feel free to contact Toronto naturopathic doctor, Dr. Courtney Homberg at 647-351-7282 to schedule your appointment today.

The use of hormonal birth control is one of the most common and effective ways to prevent pregnancy, as well as manage unwanted symptoms of reproductive health. Hormonal birth control, whether a pill, an implant, or a patch, all function in a fairly similar way. They introduce synthetic hormones into the body to prevent ovulation and increase cervical mucus – a tandem effect that helps prevent pregnancy. Birth control pills are also prescribed to help alleviate symptoms of certain gynecological conditions, like endometriosis, and regulate menstruation. However, if you have been diagnosed with a chronic gut dysfunction disorder and are struggling to treat it, your birth control may be an attributing factor. ​ Sex Hormones and Your Microbiota Women account for more annual diagnoses of chronic gut dysfunction than men.[1] A growing body of evidence has demonstrated that the fluctuation of the female reproductive hormones estrogen and progesterone have been demonstrated to be contributing factors in the onset of digestive dysfunction.[2] The relationship between hormones and the gut is symbiotic; one affects the other. Evidence shows that women with IBS report a higher incidence of PMS and dysmenorrhea (painful periods)3, suggesting gut dysfunction seems to have a negative impact, at minimum, on the regulation of hormones and perception of pain. Conversely, there is mounting evidence demonstrating the impacts of sex steroid hormones on the gut microbiota. To date, studies demonstrate clear evidence that specific phyla, family and genere variances to the microbiome of rodents result from gonadectomy and hormone replacement4. In adult rats who undergo ovariectomy, shifts in the relative abundances of two major phyla, Bacteroidetes and Firmicutes were demonstrated. Furthermore, we see this demonstrated in humans during pregnancy, and between sexes. Men have higher concentrations Bacteroidetes and Prevotella than women,5,6 suggesting a role for sex chromosomal gene expression or differences in gonadal hormone levels in the modulation of the gut microbiota. Koren et al7 also found a large shift in the gut microbiota from the first to the third trimester of pregnancy women, with an increase in overall diversity and a proliferation of Proteobacteria and Actinobacteria (and resultant changes in metabolism). Lastly, we see exacerbations of pre-existing inflammatory bowel disease in women on oral contraceptives8. This poses an important question – do synthetic hormones, like the ones in birth control, further upend the balance and fluctuations of our microbiome? ​ So what does this mean for someone on a birth control pill? Well, we know that hormones influence the gut microbiota, and an improperly functioning microbiome can lead to several comorbidities, such as: Increased Intestinal Permeability (what the internet likes to refer to as “Leaky Gut” – undigested proteins, micronutrients, and potentially toxins that pass through the lining of your intestines inappropriately, often triggering an immune response. Gut Dysbiosis – a general state of imbalance of gut flora that can cause bloating, gas, acne, mental fog, constipation, indigestion, diarrhea, etc. Small Intestinal Bacterial Overgrowth – the overgrowth of bacteria in the small intestine which can cause cramping, bloating, diarrhea, constipation, indigestion, and gas. Gallstones – when gallstones develop they can impede the secretion of bile, leading to chronic pain, bloating, and gas. Allopathic medicine often resorts to gallbladder removal surgery to mitigate symptoms. Rebalancing the Imbalance To improve or eliminate the symptoms of chronic gut issues, switching to non-hormonal birth control may be an option for you. However, if you are using birth control to treat another underlying gynecological condition it may not be in your best interest to simply stop taking it. Always speak to your Doctor and Naturopath before discontinuing any medication to ensure this option is right for you. If non-hormonal interventions are not an option, it is important to focus on rebuilding and supporting a healthy gut microbiome. One of the best ways to support our microbiota is to eliminate foods from the diet that can lead to further imbalance. Cut back or eliminate: High-fructose corn syrup Artificial sweeteners like aspartame, sucralose, and saccharin, along with sugar alcohols (xylitol, sorbitol, mannitol, etc) Processed refined sugar Foods that are artificially coloured Pre-packaged or ready-made foods Fried foods. It is also important to eat a diverse diet rich in whole foods to feed our microbiota and increase the production of a very important short-chain fatty acid, known as butyrate. Butyrate helps to not only improve digestion, but to decrease inflammation, and is increased by the following foods: Prebiotic foods -- artichokes, asparagus, and garlic (not FODMAP friendly) Legumes -- green beans or black beans Fruits – strawberries, mangoes, and melons Fermented foods – sauerkraut, yogurt, kefir, or kombucha Prebiotic fibres, like acacia gum and guar gum For more guidance and help support your gut health, hormones, and achieving a healthy balance, please feel free to schedule an appointment online with Dr. Courtney Homberg, Naturopathic Doctor in Toronto, or by calling the clinic at 647-351-7282 today! [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3569485/ [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322543/ 3 https://www.ncbi.nlm.nih.gov/pubmed/16552294 4 https://www.ncbi.nlm.nih.gov/pubmed/27700135 5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1392899/ 6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4398427/ 7 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505857/ 8 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928680/