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/

We all know that getting enough sleep is important. But how important? Sleep impacts our mental health, emotional health, and physical health. But with our busy lives and hectic schedules, it’s often easy to put a good night’s rest on the back burner. Sometimes, even when we get into bed at a reasonable hour, we may not be able to fall asleep or stay asleep. However, recent research confirms continuous sleep deprivation can have more far-ranging consequences on health than we may have once realized, with negative impacts demonstrated on our intestinal microbiomes, immune system, insulin resistance and weight management, amongst a myriad of other health issues. Sleep and Your Microbiome: A Two-Way Street It may be tempting to think that a couple of late nights won’t hurt in the long run, but not getting enough sleep affects your gut health much sooner than you would expect. A 2016 Swedish study showed that after just two nights of less than six hours of sleep, the number of certain beneficial gut bacteria strains was reduced by almost half, while less desirable strains increased in numbers. To make matters worse, the study participants were almost 20% less sensitive to insulin (1), which will result in higher blood sugar levels and increased risks for diabetes. Our second brain — the digestive tract — also has a huge impact on how much sleep and the quality of sleep we get, too. Our microbiome plays a role in our moods, hormones, neurotransmitters, and stress levels — all of which can affect our sleep. Interestingly, about 60-90% of patients with IBS symptoms report mood conditions, such as depression, anxiety and insomnia. Stress hormones, particularly cortisol, adrenaline, and norepinephrine, are all demonstrated to increase significantly under states of sleep deprivation. Mice models have now confirmed that mice exposed to stress have 68% reduction in the diversity of their microbiome, and 72% increase in GI-related disorders when compared to controls (2). What’s even more interesting is that the use of a specific probiotic, L. rhamnosus JB-1, increases GABA reception in the hippocampus through the vagus nerve, and reduced stress-induced corticosterone and anxiety/depression-related behaviours (3). To optimize the health of your microbiome, ensure to: Eat a whole foods, plant-rich diet. Eat probiotic foods, like yogurt, kefir, sauerkraut and kombucha (if they’re tolerated, and if you don’t have SIBO) Add prebiotic foods, like artichokes, asparagus, and apples, to your diet (if they’re tolerated, and if you don’t have SIBO). Avoid refined sugars, simple carbohydrates, and processed foods. Get regular exercise – this lowers your cortisol and improves your sleep quality. Consider testing your microbiome Improve Your Sleep Habits to Improve Your Gut Health Stay away from electronics — especially before bedtime. While many cell phones and other electronics now come with a nighttime setting, the stimulation from screen time can still disrupt melatonin production. Turn off your devices about two hours before bedtime to ensure your brain is relaxed and ready for sleep. Keep your room dark and cool. Ambient light can disrupt circadian cycles and melatonin production. Consider purchasing blackout curtains to reduce exposure to ambient light from outside, cover the LCD screens of clocks and electronics, and make sure to turn off the television. Turning down the thermostat is also conducive to a good night’s rest. Stick to a regular bedtime — even on the weekends. It’s tempting to stay up on the weekends in order to fully maximize our downtime. However, our bodies are designed to stick to a routine and a disruption to that routine will impact circadian rhythms. Limit your caffeine intake. Make sure to check your favourite teas for caffeine and skip the coffee after lunch. If you need a midday boost, consider taking a B-complex vitamin or some adrenal-supportive herbs for a natural pick-me-up that won’t impact your ability to fall asleep. For more information about your digestive health, or to discuss your sleep concerns, please feel free to contact your local Toronto Naturopath, Dr. Courtney Holmberg, ND. Book an appointment online or call 647-351-7282 today! Sources: Benedict, C., Vogel, H., Jonas, W., Woting, A., Blaut, M., Schürmann, A., &Cedernaes, J. (2016). Gut microbiota and glucometabolic alterations in response to recurrent partial sleep deprivation in normal-weight young individuals. Molecular Metabolism, 5(12), 1175-1186. doi:10.1016/j.molmet.2016.10.003 Rea K, Dinan TG, Cryan JF. The microbiome: A key regulator of stress and neuroinflammation. Neurobiol Stress. 2016 Mar 4;4:23-33. eCollection 2016 Oct. Javier A. Bravo, Paul Forsythe, Marianne V. Chew, Emily Escaravage, Hélène M. Savignac, Timothy G. Dinan, John Bienenstock, and John F. Cryan. Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve. PNAS September 20, 2011 108 (38) 16050- 16055; https://doi.org/10.1073/pnas.1102999108

Millions of people around the world live with autoimmune disorders, which is why it’s so important that our understanding of these disorders continues to grow rapidly. A growing body of research suggests that chronic illness responds best to a multifaceted methodology of diet and lifestyle changes that include a focus on anti-inflammatory nutrition, moderate exercise, adequate and plentiful sleep, and reasonably reducing stress. This approach to managing autoimmune disease has been termed ‘the Autoimmune Protocol’ (AIP) and may be the key to successfully managing autoimmune disorder symptoms. What you eat matters. What we put into our bodies has a significant impact on our health – even for those of us considered generally healthy. Processed foods, refined sugars, and saturated fats can contribute to the onset of autoimmune symptoms. But even some ‘good-for-you’ foods may affect gut flora and result in the recurrence of autoimmune symptoms. To allow the body to heal from the effects of autoimmune symptoms, it is important to stick to nutritionally dense foods, but more importantly, avoid ingredients that promote inflammation and hence immune activation. Such items include: Processed vegetable oils: corn, canola (rapeseed), palm kernel, peanut, safflower, sunflower and soybean oil Processed food chemicals: artificial colours and flavours, emulsifiers (carrageenan, cellulose gum, guar gum, xanthan gum, lecithin), monosodium glutamate (aka MSG), nitrates/nitrites (naturally occurring are ok), phosphoric acid, propylene glycol, textured vegetable protein (aka TVP), trans fats (hydrogenated and partially hydrogenated vegetable oils, such as margarine), yeast extract, and any chemical on a label you don't recognize or can’t pronounce. Problematic sugars and sweeteners: agave/agave nectar, barley malt, brown rice syrup, cane sugar, caramel, corn sweetener, high fructose corn syrup (really, any corn syrup), crystalline fructose, dextrin, dextrose, evaporated cane juice, fruit juice concentrate, galactose, glucose, inulin, lactose, monk fruit, maltose, maltodextrin, rice syrups, sorghum syrups, sucrose/sucralose, and of course, refined sugar Instead, replace for: Olive oil (at room temperature) or avocado oil when cooking (due to high smoke point and low trans/saturated fats Vegetables such as beets, asparagus, sweet potatoes, and kale Fruits as a sweet treat, such as apples, figs, grapes, and melons Sweeteners such as stevia or erythritol (if you have no gastrointestinal issues) When you eat matters. Just as important as what we put into our bodies when we put nutrition into our bodies also matters. According to recent studies [1], disruptions to our eating and fasting cycles can contribute to an imbalance in gut microbiota and an increase in inflammatory responses. Try to avoid forcing eating when feeling stressed. Avoid eating late at night, before bed, or during the night. Stick to regular mealtimes instead of grazing throughout the day. Exercise to improve your gut biome. Many autoimmune disorders are stress-triggered. Regular aerobic exercise has been recommended for decades as a natural and healthy way to reduce stress and cortisol levels while increasing feel-good endorphins. Exercise can help to manage the symptoms of chronic illness. But beyond merely symptom management or de-stressing, exercise can improve your gut biome (which we know to be a key factor in the development of autoimmunity). In a recent study [2], scientists studied participants just beginning an exercise regimen. For several weeks during active exercise, the researchers discovered the increased presence of microbes that produce short-chain fatty acids – the acids that help repair damage from inflammation, fight insulin resistance, and help boost metabolism. The presence of these microbes was significantly diminished after participants stopped exercising regularly. Manage your lifestyle. Our constantly-connected sleep-deprived lifestyles are doing more harm than good – especially to our microbiota – and may be contributing factors, along with diet, to the development of autoimmune disorder symptoms. To mitigate these symptoms, it is important to get plenty of sleep and eliminate as much unnecessary stress from daily life. Mindfulness meditation – meditation has been shown to reduce stress, give us a deeper sense of well-being, and help regulate circadian rhythms. It’s also been shown to change our microbiome. Digital detox – being constantly connected not only exposes us to excessive amounts of light but keeps our stress levels up. At least an hour before bedtime, turn off all electronic devices and turn down the lights. Get outside – fresh air and natural light can help restore natural circadian cycles and help reduce stress. Connecting barefoot with the grass, also known as grounding, “reduces pain and alters the numbers of circulating neutrophils and lymphocytes, and also affects various circulating chemical factors related to inflammation” [3]. For more help with supporting your gut health, achieving a balanced lifestyle/diet, or general health guidance in autoimmunity, 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! ​ References: [1] https://www.gutmicrobiotaforhealth.com/the-gut-microbiota-clock-the-close-connection-between-gut-microbiota-dietary-patterns-and-the-circadian-rhythm/ [2] https://pubmed.ncbi.nlm.nih.gov/29166320/ [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378297/

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.

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!

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.​

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.

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 [2]. 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 [3]. 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 [4]. 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#

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.

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/