Hair thinning and/or hair loss is a familiar experience for many, especially as we age. It’s a topic close to home, as I’ve struggled with my own personal battle with hair loss. Until recently, the cause of male or female pattern baldness was not widely understood and thought to be primarily to be an inherited trait. But it turns out that a specific androgen – DHT – plays a significant role in hair loss. ​What is DHT? Dihydrotestosterone, or DHT, is an androgenic hormone derived from testosterone. We often think of testosterone as being mostly a male hormone, but it can also be found in smaller amounts in females and is essential for mood, energy, and reproduction. ​ In men, the androgen group of hormones, including DHT, play a significant role in the development of male sex characteristics such as deepened voice, body hair growth, increased muscle mass, growth of male reproductive organs, and how fat is stored in the body. While testosterone is the most abundant androgen found in men, playing the greatest role in controlling and maintaining many physiological and reproductive processes, DHT also helps influence these processes. In fact, DHT has been demonstrated to be 2.5x more biologically active than testosterone, however, it is found in significantly smaller amounts. ​ How does DHT impact Hair Loss It was once believed that genetics and testosterone were to blame for hair loss. However, evidence now suggests that it is less about the amounts of circulating testosterone, and more about the levels of DHT binding to the scalp follicle itself that are important in hormonal hair loss. About 10% of the body’s total testosterone converts to DHT each day for both men and women (1). The Type II 5-alpha reductase enzyme lives in the body’s hair follicle’s oil glands. Hair loss occurs when higher than-normal levels of DHT attach to the hair follicles and shrinks them, shortening the growth cycle of the hair follicle. This also leads to brittle hair, hair that falls out too easily, and resultant balding. Signs of elevated DHT in men will often present as: - baldness (male-patterned) - prostatic enlargement - acne - aggression - sleep apnea and in women as: - hair loss (diffuse thinning, may be predominant in the crown or anterior hairline) - increased body hair growth (chin, chest, nipples, abdomen) - acne - androgenic PCOS Genetics Are Still a Factor You can inherit baldness from either parent. Generally speaking, if one or both parents experienced male or female pattern balding, you will as well. Variations in the androgen receptor gene can make you more prone to the effects of DHT on hair. Additionally, the size and shape of your head can also affect how quickly DHT can shrink hair follicles. Reducing DHT There are several medications widely available that have proven to be effective in lowering DHT production and inhibiting receptor binding. But DHT blockers can have unwanted side effects, like erectile dysfunction, rash, vomiting, and congestive heart failure. Furthermore, they often provide short-term results, and lose their effect once discontinued. There are natural alternatives that have limited, yet promising, research as safe and effective treatment options in reducing DHT production: Caffeine: Your daily cup of coffee may be helping your hair grow. A 2014 study (2) found that caffeine can promote keratin production and extend the hair growth phase. Vitamins B-6 and B-12: Deficiencies in these essential vitamins can cause brittle hair or hair to fall out. Adding berries, vegetables, and almonds to your diet will increase your B-6 intake. B-12 is most commonly found in meats like tuna and beef, but can also be found in your cup of yogurt. Make sure to take a supplement if your diet is vegetarian or vegan. Pumpkin Seed Oil: Another 2014 (3) study found that men who took 400 milligrams of pumpkin seed oil every day saw an increase in scalp hair count. Saw Palmetto: limited research shows this herb may have promising effects due to its ability to block the 5-alpha reductase function. It’s used more predominantly for prostate enlargement but has potential benefits for androgenic hair loss due to its mechanism of action. Topical Melatonin: multiple studies site the use of topical melatonin to be an effective therapy for androgenic hair loss in women, showing a 2- to 3-fold reduction in hair loss volume after 3 months of use (4). This is a therapy I’ll often have compounded for patients who demonstrate findings of androgenic alopecia that is not responding to oral therapies. Collagen: With age, your body becomes less efficient at producing collagen and replenishing cells in the dermis. One eight-week study in 69 women aged 35–55 found that taking daily collagen supplements significantly improved skin elasticity compared to a placebo (5) A NOTE on supplementing Biotin: May online blogs will site biotin as an effective therapy for hair loss. However, these results are not demonstrated in the research. Deficiencies in biotin can lead to hair loss, but supplementing with biotin when you are not deficient will likely have no added benefit. I tested this theory by taking biotin for 6 months at 5 g daily, with no benefits seen to my hair loss or regrowth. Lastly, it's important to note that androgenic alopecia is not the only cause of hair loss in women and men alike. Heavy metals, iron deficiencies, thyroid dysfunction, and Telogen Effluvium are amongst the other most common causes. Furthermore, the life cycle of a hair follicle is roughly around 100 days, so it may take that long before results are noted. This is why a full workup by your naturopath is important before trying these therapies at home. If you are worried about thinning hair, there is hope. If you are concerned that your hormonal health may be impacting hair loss, or wish to discuss treatment options, please contact your Toronto Naturopathic Doctor, Dr. Courtney Holmberg at 647-351-7282 to schedule your appointment today. References: https://www.yourhormones.info/hormones/dihydrotestosterone.aspx https://www.ncbi.nlm.nih.gov/pubmed/24836650 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017725/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3681103/

Acne is easily one of the most common concerns I see in day-to-day practice, often as a result of patients seeing little long term results from the common allopathic treatments. A dermatologist may prescribe topical creams, antibiotics or a contraceptive pill to manage your skin, and while these may clear up acne for the time being, breakouts can easily recur if you stop taking your medication. That's not to say these interventions don't have a place, and everyones skin has unique needs, but by addressing acne from a more internal and holistic approach, such as lifestyle and dietary changes, acne management tends to be more long term and effective. If you’re looking to avoid pharmaceuticals, you’ve probably taken to the internet to see where you can start to make changes. While there are many home remedies that you can try, you should also consider the time lost in experimenting. As a rule of thumb, any intervention for your skin will take approximately 90 days to see effect, since that's the rough duration of time it takes for the changes you make to effect the cells in your body - predominantly your hormones. ​In my opinion, the primary advantage to seeing a naturopath to help with acne it eliminates a lot of the trial and error. In some cases, hormone testing may uncover the reason your skin is struggling, helping to streamline the treatment process to your direct needs. Alternatively, sometimes acne may be caused by secondary issues such as gut dysbiosis, thyroid dysfunction or inflammatory responses. The goal of naturopathic acne treatments not only clear pimples, but to correct the underlying cause to the skin issues in the first place. Common treatment approaches with often include the following: Dietary guidelines to reduce inflammatory and support collagen synthesis Lifestyle changes to limit the exposure of the face to bacteria Proper methods of exercise to avoid making acne worse Proper hydration Ways to properly cleanse your face without placing it under undue strain or stripping its natural microbime Natural remedies where augmenting diet and lifestyle is necessary Treating Acne Naturally: Where to Start? Get a head start on your treatment with the following tips: Clean up your diet and inflammation by removing refined and highly processed food. If you havent tried it already, avoid all dairy (that includes cow, goat and sheep), eggs, and peanuts. Theses are the three most commonly correlated foods to cystic acne and can make a huge difference in your skin. You’ll need to cut them for three full months to see results. Make sure you drink at least 2 liters of water a day. This not only helps to flush your system, but internal hydration is crucial to normalizing your skins oil production, so don't skip this step. Less is more - reach for simple makeup routines and treatment products. It’s tempting to hide the acne with layers of foundation, but using the wrong type can increase inflammation. Furthermore, harsh cleansers will strip the skins natural barrier protection and modify its pH, leading to a more acne prone skin. Take steps to relax. Stress exacerbates flare-ups by driving cortisol and insulin disregulaiton. Start meditating, enroll in a fun, creative class, or set aside time to read or unwind with healthy habits. My personal favourite - spend time in nature. Get some sun. You should spend about 15 minutes in the sun every day without sunscreen and some skin exposed for optimal Vitamin D levels. Don’t pick at the pimples, or you’ll increase the risk of scarring and further breakouts. Everyone tells you this - I know, but if you rupture the acne cyst into your dermal layer, you’ll be left with a permanent hole in the skin. Resist the temptation and try a salycylic acid acne patch instead. Clean makeup applicators, your bed linens, and your towel once a week. Pillow cases should be switched out every 3 days. When Should You See a Naturopathic Doctor for Acne? If the above remedies provided no help, your issue may go beyond simple complexion imbalance or inflammation. This is where more thorough testing and treatments may be required. Naturopathic medicine focuses on investigating the root cause of acne, and correcting imbalances within the body to prevent flare-ups. The goal is to not only eliminate acne, but leave the skin naturally clear and glowing long term. If you’re looking for thorough testing and a more personalized plan that treats the underlying cause to your acne, call 647-351-7282 to schedule your appointment with Dr. Courtney Holmberg, ND today.

We all know chronic stress, improper diet, infections, and medications like antibiotics can all create poor gut health, but did you know your gut health may also be impacting your hormones? The reason for this starts with our gut microbiome (aka the collection of bacteria in the gastrointestinal tract), and maintaining a healthy microbiome is essential to hormonal health, as the two are closely intertwined. Microbiome and Estrogen, aka ‘The Estrobolome’ When it comes to hormonal regulation, the microbiome has various functions, including Improving the synthesis of neurotransmitters and hormones Influencing the absorption of micro and macronutrients (which are often cofactors or hormones and neurotransmitter production and function) Regulating the immune system Aiding in estrogen’s clearance through the digestive tract Influencing the metabolism and absorption of cholesterol, which is the backbone to all sex steroid hormones improves insulin sensitivity which benefits weight management and prevents type II diabetes More specifically, there is a collection of bacteria present in the gut that serve to modulate and regulate the body's elimination of estrogen levels, termed ‘the estrobolome’. Evidence shows that the bacterial influence of estrogen’s metabolism can impact everything from mood, weight, and libido, as well as endocrine disorders like PCOS, endometriosis, and even breast cancer. ​ To understand the relationship, we must first understand estrogen’s life cycle. The adrenal glands and ovaries create estrogen after puberty. It circulates through our bloodstream and binds to receptors to communicate with our brain, reproductive organs, bones, heart, etc. It is then carried to the liver to be broken down and excreted with bile into the gut to be eliminated. However, estrogen in bile comes into direct contact with the microbiome, and an enzyme known as beta-glucuronidase is made by these bacteria. Beta-glucuronidase plays an important role in carbohydrate digestion, micronutrient absorption and bilirubin resorption and hence influences how metabolized estrogen is reactivated and resorbed into our system. Imbalances in these flora result in imbalances in this enzyme, an ultimately secondary excesses or deficiencies in the body’s estrogen levels, which is where symptoms begin to arise. Signs Your Gut Health May be Impacting Your Hormones Although gut health and hormone imbalance are popular topics, many people may not recognize the symptoms. Here are some of the first signs that your hormonal symptoms may be attributed to an unhealthy gut: Weight changes, especially weight gain Digestive issues such as gas, bloating, constipation or diarrhea Fatigue, despite good sleep Food sensitivities or intolerances PMS symptoms, painful cycles or heavy bleeding Anxiety, depression or extreme mood swings Acne Bloating and water retention In men, estrogen helps in sperm maturation and libido maintenance, and imbalances may correlate to infertility, low sex drive, depression, weight gain and fatigue. In women, estrogen regulates body fat and weight gain and is vital for cardiovascular health, brain function, and bone health. For women, gut health and menstrual cycles are closely intertwined. When the gut is healthy, the astrobleme produces optimal levels of beta-glucuronidase. However, too much of this enzyme causes the body to resorb excessive amounts of estrogen and may contribute to estrogen dominance symptoms. Too much estrogen in the body can lead to fluid retention and bloating and in some cases, may attribute to worsened PMS symptoms like heavier periods, cramping, bloating, and mood swings. How to support a healthy gut and hormones #1 - Start by incorporating gut-friendly foods into your daily meals: Some of the best foods to eat for a healthy microbiome are fermented foods that are rich in pre and probiotics, like sauerkraut, kimchi, yogurt and kefir. Ditch the kombucha. There's usually too much sugar. #2 - Keep up with fibre: Fibre is food for the good guys, helping to increase colonization of the bacteria most helpful in metabolising and eliminating hormones. It also increased production of a short chain fatty acid called buyrate, which reduces inflammation & colon cancer risk, improves insulin sensitivity, protects your brain and heart, and prevents gastrointestinal problems. #3 - Stick to unsaturated fats: Eating a diet full of healthy fats is important for your endocrine system, since all hormones are synthesised from fats. Foods such as olive oil, nuts, chia seeds, and fresh fish have an ample amount of healthy fat. #4 - Ditch the sugar: You heard me right. Sugar promotes inflammation which has been shown to negatively impact our healthy microbiome, and also doubles as a food source for bad bacteria and yeast. A higher sugar diet has been directly correlated to a more imbalanced microbiome, as well as endotoxemia - the absorption of toxins through the gut due to a compromised barrier (aka leaky gut). #5 - Eat your greens: Not only does a diet rich in dark leafy greens help to reduce inflammation, but research suggests that consuming dark leafy greens can help promote the development of good gut bacteria as they contain a specific type of sugar called sulfoquinovose. This sugar is used as an energy source to promote heal, thy bacteria grow. grow any greens also contain numerous antioxidants and sulforaphane which help with healthy phase I and II detox of hormones through the liver. When to consider Naturopathic Medicine Try cleaning up the diet and lifestyle factors to see if you can balance out your symptoms, but it is essential to consult with your doctor before supplementing products. Taking the wrong probiotics or trialling with supplements before knowing that a hormonal imbalance exists may actually have negatively impacted your estrogen levels and gut health. Dr. Courtney Holmberg ND, is a Naturopathic Doctor in Toronto who offers several methods of testing to determine issues with gut microbiota and reflective hormonal imbalances to ultimately correct bacterial imbalances and hormonal symptoms and improve your quality of life. Contact us at 647-351-7282 to book an appointment and learn more. References: Chen Z, Radjabzadeh D, Chen L, et al. Association of Insulin Resistance and Type 2 Diabetes With Gut Microbial Diversity: A Microbiome-Wide Analysis From Population Studies. JAMA Netw Open. 2021;4(7):e2118811. doi:10.1001/jamanetworkopen.2021.18811 Kwa M, Plottel CS, Blaser MJ, Adams S. The Intestinal Microbiome and Estrogen Receptor-Positive Female Breast Cancer. J Natl Cancer Inst. 2016 Apr 22;108(8):djw029. doi: 10.1093/jnci/djw029. PMID: 27107051; PMCID: PMC5017946. Samantha M. Ervin et al. Gut microbial β-glucuronidases reactivate estrogens as components of the estrobolome that reactivate estrogens. PROTEIN STRUCTURE AND FOLDING. VOLUME 294, ISSUE 49, P18586-18599, DECEMBER 2019 https://www.unimelb.edu.au/newsroom/news/2016/february/sweet-discovery-in-leafy-greens-holds-key-to-gut-health#:~:text=%22SQ%20is%20the%20only%20sugar,but%20abundant%20in%20biological%20organisms.

SIBO, short for small intestinal bacterial overgrowth, affects thousands of Americans every year. Much like the name suggests, it’s a disorder caused by the presence of otherwise normal colonic flora growing in the wrong location - your small intestines. Issues arise when the gasses produced by this flora impact the small intestine’s enteric nervous system, resulting in changes in movement and increased sensitivity to pain, among other concerns like gas and bloating. ​ ​SIBO is a non-threatening but annoying condition that often causes long-standing issues if left without treatment. Learning you have SIBO can often be both a worry and a relief, as it provides some direction as to the underlying cause of your otherwise ‘IBS’ labelled symptoms. But what happens when you present with all the symptoms of SIBO, but your breath test results come back negative? Is that the end of the road for the microbiome's role in your gut issues? ​ What Is SIBO? ​ Your colon is currently hosting bacteria in large quantities to help break down food and absorb nutrients, even as you read this article. SIBO refers to these same organisms crowding in your small intestines, leading to irregular stools like diarrhea or constipation, gas, bloating abdominal pain and sometimes even belching and acid reflux. SIBO is generally categorized into either a hydrogen-dominant or methane-dominant overgrowth, however, today’s doctors have learnt there may be a third source of SIBO symptoms: Methane-dominant SIBO, showing elevated CH4 gasses on a SIBO breath test and caused by methanogenic archaebacteria Hydrogen-dominant SIBO, producing elevated H2 gasses on breath tests, often causing fast transit time and/or loose stools. Hydrogen sulfide-dominant or H2S, also often produces loose stools but is much harder to detect (not visible on standard SIBO breath testing) HS2 SIBO, methane dominant SIBO, and hydrogen dominant SIBO have correlational symptoms, but the most common symptoms include: Bloating Acid reflux Chronic abdominal pain Belching Constipation Diarrhea Bladder pain Secondary symptoms such as joint pain, brain fog and fatigue are also commonly reported. Hydrogen sulfide overgrowth also uniquely may present with very malodorous gas and bad breath. Testing for Hydrogen Sulfide SIBO ​ Your physician will rule out other infectious and gastrointestinal disorders before diagnosing you with a SIBO. A lactulose breath test is used to do this - involving ingesting a non-digestible sugar solution that produces methane and hydrogen sulfide gas as gut bacteria ferments it. If these gasses spike quickly into testing, it's a telltale indicator of a SIBO diagnosis. However, when a SIBO breath test shows negative results, it doesn't confirm that a hydrogen sulfide overgrowth has been ruled out, as breath testing (to date) is not readily available for this type of gas. The Trio-Smart test, which has been developed in collaboration with SIBO researcher Dr. Mark Pimental, does have the potential for H2S diagnosis, but has yet to be adopted as a gold standard diagnostic technique and is not yet available in Ontario at the time of this article. While not as reliable as breath, stool testing is sometimes necessary to detect the presence of hydrogen sulfide flora. According to clinical data, people with IBS and poor gut health are twice as likely to test positive for SIBO than the average person. Related health conditions associated with SIBO also include rosacea, fibromyalgia, ulcerative colitis, hypothyroidism, metabolic disorders, and arthritis - however, there is still a lack of data to confirm if the treatment of SIBO can resolve these conditions. Hydrogen Sulfide SIBO Treatment While H2S SIBO is often treated similarly to SIBO with antimicrobials, the therapies chosen are often different, as bacterial resistance occurs with many of the traditional first-line SIBO interventions and can often be why patients experience partial or minimal recovery from SIBO treatment. Important adjunctive therapies to integrate for success still include biofilm management and strain-specific probiotics alongside antimicrobial treatments. Furthermore, while many SIBO treatments no longer recommended restrictive diets, hydrogen sulfide overgrowths will see more significant symptomatic improvements from a low-sulfur diet and will be driven by the intake of certain fructooligosaccharides and sugar alcohols. Lastly, if you suspect that you have SIBO, get a proper diagnosis before proceeding with a treatment program. Accuracy of therapies, as well as a proper diagnosis, can save time and headaches, as well as your good microbiota, down the road. To learn more about SIBO, proper diagnostic assessments, and accurate treatment options, please contact Toronto Naturopathic Doctor, Dr. Courtney Holmberg at 647-351-7282 to schedule your appointment today.

Insulin is a metabolic hormone that plays a valuable role in helping the body utilize sugar as fuel, and is, therefore, a key hormone in the regulation of our body weight. The body breaks down and absorbs glucose (aka sugar) through our intestinal walls and into our bloodstream, commonly referred to as our ‘blood sugar’. From there, the glucose moves into our extracellular fluid to be burned as energy within our cell or stored for future needs in the form of adipose tissue, or ‘fat’. When our blood sugar rises after consuming glucose, our bodies also signal the release of insulin, which is the key hormone to ‘unlock’ the cell and allow the glucose to enter and be utilized as fuel. However, for some individuals, the cells begin to resist the reception of insulin, commonly referred to as insulin resistance. In this circumstance, the pancreas produces the insulin, but the cells do not respond, often triggering more insulin release, but also funnels the glucose towards storage instead of burning ... which = fatigue + weight gain. Progression of Insulin resistance, when unmanaged, ultimately leads to type 2 diabetes, where the pancreas can no longer keep up with the increased insulin demand, and blood sugar levels climb. We also see certain conditions, such as PCOS, hyperandrogenism, and genetics increase the likelihood of this phenomenon. However, there are several tips and techniques you can follow to minimize spikes in your blood sugar, and ultimately lower your risk for or reverse insulin resistance altogether. Easy tips for improving insulin sensitivity in the body Get enough rest - Lack of sleep can increase the risk of heart disease and diabetes by driving up your blood sugar. Less sleep means more time awake, and the more you’re awake, the more you’re exposed to a hormone called cortisol. Cortisol works to increase your blood sugar levels through a process known as gluconeogenesis, where it pulls stored sugar from your liver to increase levels in your bloodstream. Keep stress levels low - Stress can hamper the way our hormones are produced, by following the same principles just mentioned. Stress is like hitting the gas pedal on cortisol production, driving up your blood sugar. Finding outlets to help manage or often stress will help keep blood sugar levels more stable, but also offset the resultant sugar cravings that often coincide with stressful states. Keep moving - Exercise helps lower blood sugar levels and increase insulin sensitivity by putting you in a ‘catabolic’ state, which exhausts the available sugar within the cells and forces the cells to look for more sugar resources from the bloodstream (or stored fat). Think of this process as using what’s stocked on the shelves vs going out and shopping for more. Because the body needs the energy to perform the activities, the body will be more inclined to respond to insulin signals vs resist them. Choose soluble fibre - There are two types of fibre, one soluble and the other insoluble. In brief, soluble fibre can dissolve in water, while insoluble fibre cannot dissolve in water and is harder to break down in the body. Soluble fibre helps the cells improve their response to insulin by stabilizing the rate at which blood sugar levels climb. It prevents spikes in blood sugar which lessens the reactionary spikes in your insulin levels. It also complements the good gut bacteria (which further support healthy blood sugar levels), so it’s a two-for-one benefit. Eat vegetables - Fresh vegetables (especially dark leafy greens) provide the body with essential nutrients, fibre, energy, and nourishment, and help supply essential minerals that are catalysts to a healthy metabolism. They also act as a buffer to a higher carbohydrate diet that perpetuates insulin resistance. On that note, Eat fewer simple carbohydrates - Simple carbohydrates are not ideal for pre-diabetic or insulin-resistant patients. While it supplies energy, it also rapidly breaks down into sugar, raising the blood sugar too quickly. A rapid rise in blood sugar can make it difficult for the body to produce enough insulin to absorb it, worsening cellular resistance. Instead, reach for complex carbs that contain high sources of soluble fibre (+ pair them with good foods and protein), which all slow the rate of carb breakdown and ultimately keep the blood sugar levels more stable. Skip extra sugars - Like simple carbohydrates, sugar spikes the blood sugar levels rapidly, which is dangerous for insulin-resistant or diabetic folks. Reducing sugar intake and staying away from additive sugars is a good start when increasing insulin sensitivity. Unfortunately, this includes ‘natural’ sugars like honey and maple syrup. Adapting to a lower-sugar diet will take time, but your palette will adjust with you. Consider Fasting - Simply put (and much like exercise), fasting forces your cells to exhaust their resources and search for more, favouring a ‘burning’ vs ‘storing’ state. Leaving gaps between meals to allow blood sugar levels to stabilize, and spending longer windows of time without food intake can further benefit cellular responses to insulin. Research suggests ~ 16 hr fast is where our system begins to move into ketone production to fuel the brain, and therefore is generally where it recommends breaking the fast. However, long-window fasting needs more long-term research and may not be right for everyone, so always ensure to talk to your Naturopath before trying this option. Ultimately, the key to healthy blood sugar and healthy metabolism, in general, is to eat well, get enough rest and stay active (rocket science, I know!). For more strategies on how to maintain a healthy blood sugar level, or to explore testing for insulin resistance, please contact Toronto Naturopathic Doctor, Dr. Courtney Holmberg at 647-351-7282 to schedule your appointment today.

If you’ve ever taken birth control pills and discontinued them, you may have experienced something known as post-birth control syndrome. It generally arises within the first 6 months of discontinuation, affects women of all ages, and has a wide array of symptoms. The severity is based on several factors, including how long you took the pill, the type of pill (dosage and hormone combination), your age, liver health, bowel regularity, and overall well-being. Some of the more common symptoms one might experience after stopping the pill include acne, weight fluctuations, and hair loss, and for some women, it results in an absence of menses returning known as amenorrhea. Other less common symptoms women may experience include: Migraines Painful/Heavy Periods Headaches Bloating/Gas Anxiety/Depression Imbalances to Immune System Inflammation Hypothyroidism Changes in Bowel Movements Infertility Blood Sugar Dysregulation Do some of these symptoms sound familiar? If you have recently stopped the pill or are considering discontinuing it soon, speak to your Naturopath, as you need to understand the impacts the pill had on your reproductive system, and the ways you can support the restoration of proper bodily function to prevent the onset of these unwanted symptoms. Why Are You On the Pill? Some women start the pill to prevent unwanted pregnancies, which is what it was originally designed to do. However, for other women, doctors might prescribe the pill to help manage their acne, to control hair loss, or to mitigate heavy, irregular, or painful periods. Now don't get me wrong – in some cases, the birth control pill may be your best option. However, one must recognize that managing imbalances with hormonal replacement fails to address the underlying root of the issue, for which conventional medicine has few alternative options. Instead, birth control pills“band-aide” the problem, leaving women to once again deal with the issues should they decide to discontinue the pill or become pregnant. The pill has not resolved the imbalances. Rather, it has merely suppressed the symptoms, while the underlying issues remain unmanaged. ​ Instead, consider natural options to manage things like acne, heavy or painful periods, or hair loss. If you’re on, or considering using, the birth control pill for sole contraceptive purposes, weigh your options first. If you reference this chart released by the CDC, you’ll note that oral contraceptives, which contain combination hormones, have a 9% failure rate, meaning 9 in 100 women using the pill will become pregnant during use. However, intrauterine devices have been used globally with great success, have a less than 1% failure rate, and contain a low dose of the single hormone progesterone, or no hormones at all (if you choose the copper IUD). Side effects include cramping, heavier periods, expulsion, and a slightly increased risk of ectopic pregnancies should the IUD fail. ​Post-Birth Control Syndrome Detox Focusing on key body areas is essential for an effective post-birth control syndrome detox. The first step is to support the body’s ability to rid of the synthetic hormones that are suppressing its natural ovulatory rhythm. Both synthetic and natural hormones are processed through the liver in phase I and II conjugations, which require many cofactors to convert steroid hormones into water-soluble metabolites for excretion. I place my patients on a comprehensive micro/macronutrient and a botanical regime that provide phase I and II conjugation inducers to speed the removal of residual synthetic hormones that may be creating symptoms in post-birth control syndrome. This involves a revamp of the diet to ensure the nutrient-rich foods we desire for healthy liver detox is the center of every meal, as well as gentle lifestyle adjustments to upregulate the liver enzymes of desire. Aggressive liver detoxes are unnecessary and sometimes harmful. Secondly, rebalancing your own hormones is essential. Years of exogenous, or synthetic hormonal exposure lead to low levels of endogenous, or natural estrogen production, and as a result, when the synthetic hormones are removed, the body sometimes struggles to catch back up. I’ll sometimes use ingredients like Vitex and Inositol that help support healthy ovulation, as well as a diet high in healthy fatty acids to get patients' cycles back on track. Because your body depends on your gut to remove excess hormones, gut health should also be assessed and supported to ensure excretion and balancing of the return of your own hormones are maintained. IBS, bacterial imbalances, and delayed transit times can be some of the primary reasons women experience some of the unwanted symptoms of hormonal imbalances. Lastly, castor oil packs are a must! Castor oil applied to the liver and lower abdomen helps draw circulation and restore organ function in an incredible way! If after a few months of support, my patient's periods are not returning, or symptoms of discontinuation syndrome are still present, further assessments for underlying conditions like PCOS are conducted, and comprehensive hormone testing may be necessary to aid in the proper diagnosis of underlying conditions. ​ To learn more about post-birth control syndrome and how to detox hormones naturally, contact Dr. Courtney Holmberg, ND at 647-351-7282 today!

Can Pre- and Probiotics supplements actually improve gut health? Research and my clinic experience say yes. Probiotics have been proven to be helpful in several conditions, such as irritable bowel, yeast infections, weaken immune function, and even weight loss. There is no ‘one-size-fits-all', so choosing the right probiotic can be a tricky task. You have to first ask yourself ‘what are you looking to achieve?’. If you’re looking to improve digestive health, such as gas, bloating and irregular stools, look for a probiotic that's rich in bifidobacteria, such as b. animalis and b. infantis. For repeat yeast infections and urogenital health, you’re better off with lactobacillus species, such as l. acidophilus, l. rhamnosus and l. reuteri. Furthermore, some probiotic strains are not seen in the human microbiome but have been shown to prevent traveller's diarrhea or antibiotic-associated diarrhea, such as s. boulardii. ​That being said, unfortunately, most of the literature suggests probiotics provide benefits during use but don’t culture the gut long term. This is where prebiotics become helpful, promoting the development and strengthening of the colonies of your endogenous flora, as well as increasing the output of butyrate (a short-chain fatty acid showing wide spectrum positive effects in everything from cardiovascular disease to colon cancer prevention) One thing to note - certain probiotics can also worsen certain conditions like SIBO or histamine intolerances, so it's always best to check with a professional to ensure the probiotic you’re taking is right for you. What's the difference between pre- and probiotics? Probiotics are supplementation of exogenous (or ‘outside’) sources of bacteria that did not originate in your digestive tract. They prove to be helpful when there’s an intended outcome in mind, such as reducing gas or bloating or preventing travellers' diarrhea. The biggest downfall to probiotics is that most research concludes that lab-grown probiotics don’t successfully culture human guts. This is where prebiotics are beneficial, as they help strengthen the strains that are native to your digestive tract. You can certainly take both, depending on your desired outcome. The easiest way to compare the difference is to envision your digestive tract as a garden that needs some tending. Prebiotics are like fertilizing the flowers that already exist, and probiotics are like planting some new ones (quick results - but they may not last long term). I generally recommend probiotics for more acute concerns, symptom management, or prevention of illness (such as in travel or alongside antibiotics) and prebiotics for general health and long-term microbiome recovery. Can I get pre- and probiotics through my diet? Consuming foods rich in soluble fibre provides a natural source of prebiotics for your gut bacteria, such as flax, hemp and chia seeds, oats, bananas, kiwis, artichokes and legumes. Natural sources of prebiotics include cultures of dairy products like yogurt and kefir, sauerkraut, kimchi and other fermented foods like miso and tempeh. However, not everyone tolerates high-fibre foods well so speak to your naturopath before changing your diet. Preliminary research suggests artificial sweeteners like aspartame may have the most negative impacts on our gut microbiome, but more human-based research is required. Are some prebiotic fibres better than others? Each person is unique. Generally speaking, fibre doesn’t have favourable outcomes in IBS studies. However, someone who’s recently undergone gallbladder surgery and/or experienced diarrhea can benefit from a soluble fibre like psyllium. Soluble fibres can also help lower cholesterols and irregular blood sugar levels, as well as assist in the elimination of sex steroid hormones, like estrogen. Soluble fibre is also rich in foods like oats, beans, apples, carrots, barley and psyllium. Are there downsides to taking a prebiotic supplement? Unfortunately, fibres can often increase bloating. Since they’re fermentable, they can often be consumed by gut bacteria and increase gas formation and distension in the abdomen. They also interact with several medications, such as birth control pills, and statin medications. If you’re planning to add fibre to your diet, look for ones that are FODMAP approved, such as partially hydrolyzed guar gum, or acacia gum. Furthermore, increase them gradually and take them with a large volume of water. Lastly, make sure they’re taken 2-4 hours away from all oral medications. Can "cleanses" help improve gut health? Cutting out certain foods that induce inflammation like sugar, dairy, or high FODMAP foods can help alleviate symptoms, reduce inflammation and help the gut recover from certain acute stressors like antibiotics, diarrhea or illness. However, most ‘box’ prepared cleanses generally contain mostly laxatives and diuretics, and give a false sense of improvement by forcing bowel emptying and reducing water retention, and show no long-term benefits. Lastly, let me say this. Colonics are not an effective means of ‘cleansing’ the gut. The microbiota is a very delicate ecosystem, so I would not advise disrupting it with measures that have resulted in rectal perforation, where little to no proven benefit exists. To find out more about the right supplements, dietary approaches, and testing for your gut and microbiome, please feel free to contact Toronto naturopathic doctor, Dr. Courtney Homberg at 647-351-7282 to schedule your appointment today.

Graves disease is an autoimmune disorder of the thyroid gland resulting in an overproduction of thyroid hormone and is named after Robert Grave, an Irish doctor who described this thyrotoxicosis in 1835. The thyroid, being an endocrine gland that sits at the base on the neck, produces two important thyroid hormones, triiodothyronine (T3) and thyroxine (T4), which help us manage things like sleep, appetite, metabolism, energy, and heart rate. Understanding Grave’s Disease The origins of Grave’s Disease is not known, but it is understood to be an autoimmune response. In Grave’s, the body improperly produces antibodies (referred to as thyrotropin receptor antibodies (TRAb) or thyroid-stimulating immunoglobulins (TSI) that cross-react with the cells of our thyroid, sending the thyroid into overdrive. The overproduction of thyroid hormone is referred to as hyperthyroidism. ​Grave’s Disease symptoms include but may not be limited to the following: Increased irritability & anxiety Weight loss Hypertension and rapid and/or irregular heartbeat (palpitations) Heat intolerance Diarrhea Insomnia Development of a goitre (swelling in the gland at the base of the neck) Dry flushed skin Muscle tremors Grave’s Ophthalmology (Bulging eyes) So far, science and research show that the disease may be related to lymphatic stagnation as a result of neck injury. Food intolerances may also be associated with the development of Grave’s Disease, as does a compromised digestive system. Grave’s Disease appears to be genetically correlated, and may also be passed down through family history. Diagnosis is generally made via blood work, confirming elevated TSI to TRAb antibodies, and in some cases may also include ultrasound and/or a radioactive iodine uptake test. Is Grave’s Disease common? Grave’s Disease is one of the leading causes of hyperthyroidism in Canada, as per the Thyroid Foundation of Canada. The disease affects 1 in 100 people within the country. Start managing Grave’s Disease with Naturopathic Medicine In most cases, medication will be required to stabilize the overproduction of T3 hormone, but there are numerous natural therapies and lifestyle changes that can be done to support symptoms and more effectively maintain remission of this autoimmune disorder. Kick the habit of smoking Cigarettes increase your exposure to toxic compounds and oxidative damage, which magnifies the risk of developing an autoimmune condition. Toxic ingredients and chemicals inside cigarettes cause free radical damage to perfectly healthy cells, inducing immune activation to repair the damage and increasing the likelihood of a cross-reaction. Furthermore, cigarette smoke contains cyanide, which when metabolized to thiocyanate, can interfere with iodine concentration in the thyroid. Get more L-Carnitine L-carnitine is a natural amino acid derivative produced from our liver and kidneys as well as sourced from our diet that helps the body break down fats into energy. People with Grave’s Disease may not produce enough or may have an increased demand for L-carnitine. Evidence suggests supplementation of L-carnitine may help manage symptoms and offset cell damage caused by overproduced thyroid hormones. It may also offer protection by blocking the action of thyroid hormone, and therefore should never be used in low-functioning thyroid conditions and should always be supervised by your doctor or naturopath. You can find foods such as beef, lamb, codfish, chicken, whole wheat bread, tempeh, avocados, asparagus, and cheese to be rich sources of L-carnitine. Keep stress levels low Stress often accelerates most health conditions, and in this instance, it can increase the implications of Grave’s Disease. Stress hormones like adrenaline and cortisol not only disrupt the immune response but also increase hyperthyroidism symptoms and secondary organ damage. Toxins in the environment can increase the symptoms Toxins can disrupt the way the body functions, especially the way the endocrine system functions. Studies show that environmental exposures, most notably PCBs, nuclear and medical radiation, and increased iodine exposure, interfere with thyroid function at multiple sites, including thyroid hormone synthesis, action, and metabolism/excretion. Toxins not only negatively influence thyroid function but also increase the likelihood of autoimmune thyroid development - especially in those with a family history of thyroid disease. Eating a whole foods diet free from preservatives and chemicals can limit exposure to environmental toxins. Drinking filtered water may eliminate exposure through water/waste systems. You may wish to also explore household detergents and cleaners free of endocrine-disrupting ingredients (the Environmental Working Group’s website is a good resource to start learning about household endocrine disruptors). Remember, ‘natural’ doesn’t necessarily mean non-toxic! Add selenium Selenium is valuable for all cells and tissues but is particularly important to the thyroid gland. Selenium assists in thyroid hormone conversion as an active ingredient in the thyroid’s enzymes and assists in defending the gland against oxidative damage. The mineral also helps keep the immune system strong. Selenium is a natural mineral found in selenium-rich soil. Crops grown without this mineral won’t have selenium in them and thus, supplementation may be needed. Selenium is naturally found in nuts, eggs, meat, fish, sunflower seeds, spinach, mushrooms, and baked beans. Eating just 2 brazil nuts per day can give your thyroid a significant source of selenium. As you may notice, the thyroid, endocrine and immune system can be a complex network to manage, and support from a Naturopathic Doctor can help to find the most effective strategies and supplements for your unique needs. To access naturopathic support in the management of Grave’s Disease, please contact Toronto Naturopathic Doctor, Dr. Courtney Homberg at 647-351-7282 to schedule your appointment today. References: Hyperthyroidism (Thyrotoxicosis). Thyroid foundation of Canada. https://thyroid.ca/resource-material/information-on-thyroid-disease/hyperthyroidism-thyrotoxicosis/ Benvenga S, Ruggieri RM, Russo A, Lapa D, Campenni A, Trimarchi F. Usefulness of L-carnitine, a naturally occurring peripheral antagonist of thyroid hormone action, in iatrogenic hyperthyroidism: a randomised, double-blind placebo-controlled clinical trial. J Clin Endocrinol Metab. 2001;86(8):3579-3594. Berni A, Meschini R, Filippi S, Palitti F, De Amicis A, Chessa L. L-carnitine enhances resistance to oxidative stress by reducing DNA damage in Ataxia telangiectasia cells. Mutat Res. 2008;650(2):165-74. Pearce EN. Braverman LE. Environmental pollutants and the thyroid. Best Pract Res Clin Endocrinol Metab. 2009;23:801–813. Brent GA. Braverman LE. Zoeller RT. Thyroid health and the environment. Thyroid. 2007;17:807–809. Ventura M, Melo M, Carrilho F. Selenium and Thyroid Disease: From Pathophysiology to Treatment. Int J Endocrinol. 2017;2017:1297658.

AMAZING BENEFITS YOU MAY NOT ‘BEE’ AWARE OF Honey bees, or apis mellifera, have been helping humans since the dawn of time. They’ve not only provided us with a long-standing source of honey and wax but have played an integral part in helping our agricultural growth and in sustaining our ecosystem. Honey has been a cornerstone to most pantry shelves as a natural food sweetener or agent to soothe a sore throat. But as it turns out, our little buzzing friends and the delicious liquid they provide us are even more helpful to our health than we once thought. Modern research has discovered many bee byproducts have proven benefits on everything from our gut microbiome to our immune system, and maybe even our fertility. Honey ​ Honey has been used for millennia as a sweet treat and natural sweetener. But the consumption of honey has benefits beyond its tasty profile. Because of its potent antimicrobial properties, certain types of honey, like manuka, have been used to treat wounds, prevent and heal gastric ulcers, and minimize digestive disruptions caused by inflammatory bowel disorders. ​ ​Honey is nature’s sweet superfood, containing over 180 amino acids, vitamins, minerals, enzymes, and other chemicals, including fructooligosaccharides – which act as prebiotics. Prebiotics can help promote the growth of healthy bacteria in your gut. Some recent studies have demonstrated that honey may help improve your intestinal health by acting as a source of prebiotics to dramatically enhance the growth of beneficial bifido and lactobacilli colonic flora, as well as inhibit the harmful effects of mycotoxins (mycotoxins are toxic substances released by moulds and bacteria that have toxic impacts on our digest tract, kidneys, and other end organs) (1). Substituting honey for processed sugar seems to be a favourable alternative. Propolis ​ Propolis, or ‘bee glue’, is a resinous substance that bees produce to protect and sterilize their hives. Propolis is a unique blend of sap from trees or resin from buds, beeswax, and bee saliva. Almost all honey contains at least trace amounts of propolis. According to recent research, propolis has more than 300 compounds, including polyphenols and micronutrients. On their own, many of the properties of propolis have potent antimicrobial, antiseptic, and antifungal properties; however, some studies are demonstrating that the unique nature of propolis has incredible health benefits for the gut biome (2). Propolis has been demonstrated to: Curb the growth of pathogenic yeasts Manage and reduce the symptoms of ulcerative colitis (3) Stabilize microbial profiles and reduce endotoxin transport Propolis tinctures also make for a wonderful wound care item, preventing infection and helping to speed the rate of healing. Careful - it stings (pun intended)! Bee Pollen Bee pollen is a mixture of pollen from plants, bee saliva, and nectar that bees use to feed the colony. Bee pollen contains roughly 250 compounds that serve to provide important nutrients to the colony. This bee superfood -- packed with vitamins B, C, and E as well as trace minerals, amino acids, phytochemicals, and lipids -- has incredible nutritive and digestive benefits for humans, too. A range of studies have demonstrated the antioxidant, anti-inflammatory, immunomodulation, and pain-mediating effects of bee pollen. It has more recently also been shown to dramatically enhance the growth of Lactobacillus acidophilus, Bifidobacterium animalis, Lactobacillus casei, and Bifidobacterium animalis spp. lactis – all of which are important bacteria in our gut for assistance in immune health, digestion of carbohydrates, and prevention of infection (4). Royal Jelly Bees use royal jelly to nourish larvae and create new queens. It is packed with vital proteins, lipids, and other nutrients – although its exact chemical composition remains a bit of a mystery. For thousands of years, humans have used royal jelly for everything from beauty treatments to wound care. More recently, studies are showing some promising results when it comes to using royal jelly for improving the gut biome. Royal jelly has been demonstrated to promote the growth of healthy bacteria all while suppressing the growth of pathogens. Additionally, in another study, over several months, participants showed improved glucose tolerance and mental health (5). Amongst digestive benefits, preliminary studies in immature rats have shown that the use of royal jelly results in a significant rise in ovarian production in estradiol levels, as well as beneficial effects on ovarian follicle growth and development. It’s been deemed that royal can potentially be considered as a treatment to promote fertility (but further studies in humans are necessary) (6). How to choose the right honey First off – don't start on a grocery store shelf! Most store-bought honey is pasteurized, which means it's heated to a certain temperature to sterilize the product, resulting in denaturing of the proteins and enzymes that give it its numerous health benefits. You may argue that pasteurized honey becomes just another source of sugar. Note: unpasteurized foods should always be avoided if you’re pregnant, and should not be given to children under 1 year of age. Purity is also key if you’re seeking the added health benefits of honey. With the large demand for this tasty golden liquid, several imported honey products are cut with high fructose corn syrup, and are in fact not honey at all! Instead, seek out local apiaries using conscious and sustainable ways to maintain their bees. And don’t get hung up on ‘organic’. You can’t truly control where bees collect their pollen, so unless the farmer is in a rural area that's surrounded by only organic crops, this label is just a marketing tactic. Also, ask your beekeeper if they use their bees for pollinating. Some farmers make most of their income from transporting their bees between crops for pollination, and the honey they produce is just an afterthought. This exposes the hives (and ultimately your honey) to an increased risk of infection (and more antibiotic use) as well as more pesticides and herbicides. Instead, look for ‘wildflower’ and ‘unpasteurized’ on the labels, and ask the right questions – ensuring that your beekeeper is using best practices to sustain their hives means we’ll minimize the footprint we leave on the important role honey bees provide to our ecosystem. We source ours from a local & family-owned wildflower apiary in Balsam Lake, known as Arnold’s Apiary, or @arnoldsapiary. They use traditional harvesting techniques that purify but don't pasteurize out all the health benefits of this tasty golden liquid, and ensure they’re using sustainable systems to keep their hives thriving after harvest and through the winters. The honey is always flavourful, and changes profiles from spring to fall, depending on what’s in bloom! Visiting the hives at Arnold's ApiaryThe Bee Masters hard at work Lastly, remember that honey is still a concentrated source of glucose, and while it provides superior benefits above refined sugar, moderation is key! If you are interested in learning more about digestive health, ways to improve your microbiome, or for general health guidance, please feel free to schedule an appointment online with Dr. Courtney Holmberg, Naturopathic Doctor in Toronto, or by calling the clinic at 647-351-7282 today!

If you’ve listened to or read any of Dave Asprey or Mark Hyman's work, you've probably heard of the term biohacking. In short, it's a term used to reference quick and efficient ways to improve, or shall I saw ‘maximize’, your health and fitness to make you feel your best and live the longest. Intermittent fasting, bullet coffees, HIIT and ketosis are all examples of this trend, and at its core it is about about making shifts to your daily habits and routines to help you achieve longevity. It also focuses on the concept of nutrigenomics, which is the diet’s influence on your genetics. And while we might see acute results from these trends, like weight loss, clearer skin or more energy, the real question is what does it ultimately mean for our health long-term? Does it actually keep us younger longer, does it lengthen our lifespan, and does it truly prevent disease. Lets break down this biohacking trend and explore the answers to these questions. ​What does Biohacking your diet involve? Biohacking trends like intermittent fasting or the ketogenic diet differs from traditional diets in that it doesn't focus on counting calories or limiting the types of food you can eat—it's more about encouraging your body to be in its most optimal state. Dave Asprey, who created the Bulletproof Diet, coined the term. His diet advocates consuming only grass-fed butter and ghee (clarified butter) along with other "healthy" fats like coconut oil and avocado oil. He also suggests drinking Bulletproof Coffee daily: coffee blended with MCT oil (medium chain triglycerides) and grass-fed butter or ghee. While this diet might sound extreme, many people are embracing this biohacker lifestyle and claiming to reaping the benefits of better health, such as improved blood flow and blood pressure, increased energy level, and weight loss. These changes can also help lower the risk of certain conditions, such as heart disease. What does the research say? The data for biohacking your diet seems to show the most promising results occur when the timing of food consumption aligns with our biological clock. Unlike dietary restriction, which reduces caloric intake, intermittent fasting does not. It merely limits feeding to specific hours of the day. Studies on flies showed an extension in lifespan of 18% in females, and 13% in males when following an intermittent fasting schedule, but was only seen when food was consumed in accordance to their circadian rhythm, not just the duration of their fasts (1) (Ie. the flies that followed the same fasting window but fasted all day and ate all night did not see these same results). This is remarkable, since is provides a big clue into how fasting influences longevity. The data shows that autophagy, which is like a cellular cleaning process involving the breakdown down and elimination of cellular resources, only occurs when fasting is done at night, suggesting an important relationship between your circadian rhythm and fasting in order for it to benefit your health and longevity. Autophagy to date has been intimately linked to slowing the aging process and promoting a healthier lifespan, its exact mechanism still remains unclear (2). Is Biohacking Only Diet Related? No. The ultimate biohacking strategy can also include optimizing your sleep patterns, your movement and exercise routines, your mood, and your blood sugar/metabolic hormones. All of these factors influence the length of our telemetres, which is a component of our chromosomes that protect our DNA from damage & provide an estimate of cellular aging and influence of oxidative stress on our cells. To biohack your sleep pattern, sleep at least 7 hours per night. Sleep is essential for brain health, hormone balance, and immune system function, but more specifically, research suggests sleeping more than 7 hours per night is associated with preserving telomere length (3). To biohack your exercise, bone health, and mood, incorporate exercises such as yoga or pilates into your daily routine. These exercises are great for improving body function and muscle strength, as well as reducing stress to support our mental health. In related studies, it was reported that telomere length shortening can be reduced with moderate levels of physical activity, compared to inactivity (4). They are also beneficial to our mood, as studies show just two 60 min yoga classes per week were as effective at managing depression as the leading SSRI therapies. Moreover, the available literature suggests that inflammation significantly contributes to telomere breakdown, and that mood disorder patients are more vulnerable to low-grade inflammation and shorter telomeres, compared to healthy individuals (5). Lastly, maintaining a stable blood sugar level also appears remarkably important. Studies found that 2-h post prandial (after eating) blood glucose, but not fasting blood glucose, was inversely associated with telomere length (6). This means that its more important to focus on the volume of glucose you consume in a serving as well as what you pair it with to influence how it absorbs, vs your blood sugar in a fasted state with respect to your ‘healthspan’ (the state of your health over your lifespan). Biohacking your diet and lifestyle certianly appears to optimize all aspects of your wellness to produce better results than just focusing on one or two elements that are know to be ‘bad for you’ or are sabotaging your own efforts (like exercising more but eating junk food). However, each person is unique and not all of these recommendations apply to everyone. To learn more about ways to optimize your health, energy, and metabolism, reach out to Dr. Courtney Holmberg , ND at (647) 351-7282 to book a consultation today. References: Ulgherait, M., Midoun, A.M., Park, S.J. et al. Circadian autophagy drives iTRF-mediated longevity. Nature 598, 353–358 (2021). https://doi.org/10.1038/s41586-021-03934-0 Aman, Y., Schmauck-Medina, T., Hansen, M. et al. Autophagy in healthy aging and disease. Nat Aging 1, 634–650 (2021). https://doi.org/10.1038/s43587-021-00098-4 Lee KA, Gay C, Humphreys J, Portillo CJ, Pullinger CR, Aouizerat BE. Telomere length is associated with sleep duration but not sleep quality in adults with human immunodeficiency virus. Sleep. 2014 Jan 1;37(1):157-66. doi: 10.5665/sleep.3328. PMID: 24470704; PMCID: PMC3902878. Song S, Lee E, Kim H. Does Exercise Affect Telomere Length? A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Medicina (Kaunas). 2022 Feb 5;58(2):242. doi: 10.3390/medicina58020242. PMID: 35208566; PMCID: PMC8879766. Squassina A, Pisanu C, Vanni R. Mood Disorders, Accelerated Aging, and Inflammation: Is the Link Hidden in Telomeres? Cells. 2019 Jan 15;8(1):52. doi: 10.3390/cells8010052. PMID: 30650526; PMCID: PMC6356466. Khalangot M, Krasnienkov D, Vaiserman A, Avilov I, Kovtun V, Okhrimenko N, Koliada A, Kravchenko V. Leukocyte telomere length is inversely associated with post-load but not with fasting plasma glucose levels. Exp Biol Med (Maywood). 2017 Apr;242(7):700-708. doi: 10.1177/1535370217694096. Epub 2017 Jan 1. PMID: 28299976; PMCID: PMC5363693.

Food sensitivity testing has boomed over the past few years. Many patients come into my office inquiring about this test, and it’s something that comes highly recommended by functional medicine practitioners to help isolate foods that might be exacerbating underlying conditions. While the hopes are high with these tests can isolate food sensitivities, it's important to understand exactly what the results are telling you, and their possibility for inaccuracy depending on the method of assessment. More importantly, my concern becomes the possible nutritional deficiencies and unnecessary stressors of food avoidance on patients following excessively restrictive diets that can amount from these tests. In the end, always speak to a medical professional before ordering and testing and restricting your diet based on the results. What is Food Sensitivity Testing? Not to be confused with an allergy, IgG or “Food-Specific immunoglobulin G” intolerances are immune-mediated reactions which occur as IgG antibodies bind to a food antigen in the body, creating antibody-antigen complexes. Unlike anaphylaxis, this is considered a Type III delayed hypersensitivity reaction, and while these reactions are harmless in low numbers, a high volume of IgG antibodies has been associated with increased inflammation and a wide variety of symptoms. Since Type III delayed hypersensitivity reactions can typically occur over several hours to several days, it can be very challenging to isolate food intolerances via dietary journaling or elimination. This is where food intolerance testing may provide value. Why do Food Intolerances Occur? While research is still exploring impacts on our gut barrier, it appears the most common aggravators to our intestinal lining and probable development of food intolerances are: Gut dysbiosis High saturated fat and high sugar diets Poor dietary fibre intake Smoking Excessive use of NSAIDS Stress Furthermore, chemicals and additives in our diets that have been correlated to negative impacts on our microbiome and gut barrier are: Artificial colourants Flavour enhancers (monosodium glutamate or MSG) Sulphates (found in alcohols and some medications) Preservatives (benzoates, sorbates) Sweeteners (aspartame) Things to consider when testing The most important factors to consider when ordering an intolerance test are: Method of collection: Food intolerance testing should be collected via blood sample, measuring a quantifiable number of IgG antigen-antibodies complexes made to specific foods in your diet. Some complementary medical practices will offer intolerance testing via electrodermal screening, which is the use of computerized testing gathering feedback from energetic meridians and is not backed by literature. As such, I always advise serum assessments for my patients. Current medications: Remember that antibody testing relies on your measuring immune complexes, and therefore cannot be completed if you are taking immunosuppressant or steroid-based medications. These medications work to suppress immune-mediated reactions and will result in false negatives. It's also important to avoid testing when your body is having a severe inflammatory reaction, and you’ll likely see numerous false positives. What the results are telling you: The results will provide you with a list of foods that have associated IgG immune-mediated reactions, as well as a quantified number of antibodies that indicate the severity of the reaction, however, what it does not guarantee is the reactions’ correlation to your symptoms. Literate has shown a probable correlation of IgG reactions to conditions such as migraines, IBS, ADHD, rheumatoid arthritis, weight gain and dermatitis, but running testing does not mean that every food that shows up on your list is the source of your health issues. The process of elimination is still advisable to draw cause and effect between the results and your concerns. Speak to your naturopath about how to do this properly. All in all, food intolerance testing can certainly have the potential to provide value when looking to understand foods’ correlation to your underlying health concerns or overall well-being. What's most important is to understand when testing is indicated, and when it may not be advisable. To find out if food intolerance testing is right for you, or to explore other possibilities in how to isolate food’s influence on your health, contact Dr. Courtney Holmberg, ND at 647-351-7282 or visit us online to book an appointment.

Hormone replacement therapy has become an increasingly popular option for women seeking relief from symptoms occurring in menopause, menstrual irregularities, PCOS, amenorrhea and hypogonadism. Furthermore, people have been moving towards bio-identical hormones in hopes of a more biologically similar therapy with fewer risks and side effects. However, before embarking on hormone replacement therapy, it is important to understand the pros and cons of this form of treatment. Signs of Shifting Hormones As women age, estrogen and progesterone levels start to decline. The decrease in hormones can be the cause of a number of the following symptoms: Irregular menstruation, particularly a decrease in the frequency of menstruation Thinning hair on the head and body Vaginal dryness Decreased libido Weight gain Significant decrease in energy and chronic exhaustion Hot flashes and night sweats Brain fog, reduced concentration, and other cognitive changes Perimenopause — the period leading up to menopause — and menopause are often the culprits behind fluctuating hormonal balances and their resultant side effects. However, you do not have to be a middle-aged adult to have hormone irregularities. Some women experience a lack of cycle (amenorrhea) in their mid-20s, following a birth control pill, or in cases of polycystic ovary syndrome (PCOS), endometriosis, or untreated thyroid conditions. Risks and Benefits of BHRT The use of bioidentical hormone replacement therapy has sparked intense debate. Like all compounded hormones, BHRTs are regulated medications made from Health Canada-approved substances that require a prescription from a licensed professional. They are held to the same standards as pharmaceutical prescription substances. The primary differentiation between HRT and BHRT is the biologically identical component of the compounded formula. The chemically synthesized structures of bioidentical hormones are identical to those produced by the human body, vs biologically similar chemicals found in HRT (fun fact: birth control pills are a form of HRT). Molecular differences between synthetic progestins and progesterone result in differences in their pharmacological effects on breast tissue. Studies have found pro-carcinogenic effects of synthetic progestins on breast tissue, compared to data demonstrating ‘bio-identical hormones are associated with a lower risk of breast cancer and cardiovascular disease, and are more efficacious than their synthetic and animal-derived counterparts’ (1,2). Furthermore, transdermal vs oral estrogen preparations have been considered less likely to pose risk for blood clots, stroke and coronary artery disease (3). Some studies even go as far as to say that bioidentical hormones are the preferred method of HRT when considering safety and efficacy (2). ​ At the present moment, naturopathic doctors in Ontario have the ability to prescribed transdermal (topical) and suppository estradiol, estrone, estriol, progesterone, and oral natural desiccated thyroid. The biggest gap in research on the safety of topical hormones is that bioidentical benefits of progesterone over progestins are shown with the use of oral dosing. Topical progesterone has not been shown to increase blood serum values high enough to offset the impacts of estrogens on the endometrial lining, which when used in conjunction with estrogen replacement therapy (oral, topical, and transdermal), may increase the patient's risk for endometrial hyperplasia and cancer. Therefore, I always advise working with the right team of doctors to ensure you’re on the most efficacious and safe BHRT for your concerns. BHRT and Menopause: When diet and lifestyle measures fail, bioidentical hormone replacement therapy can be helpful in treating some of the side effects of hormonal imbalances caused by menopause. Hot Flashes, Night Sweats & Insomnia. When taken at bedtime, progesterone therapy has been shown to be significantly more effective than a placebo at improving anxiety, reducing hot flashes and increasing the quality of sleep in as little as 4 weeks (4). Unlike estrogen and other vasomotor therapies, progesterone also does not appear to cause a rebound increase in hot flashes when discontinued. Increased Energy and Cognition. Lowering levels of progesterone and estrogen have been associated with decreased energy, more anxiety, impaired cognition, and lack of motivation. Progesterone, when metabolized by the kidneys, produces a byproduct known as a-Pregnanediol, which crosses the blood-brain barrier and binds to GABA receptors, promoting a sense of calm. Estrogen has impacts on the areas of the brain associated with learning, memory, and cognitive function. BHRT (when administered within the first 5 years of menopause) may help improve energy stores, promote happiness, and reduce the risk of cognitive decline and Alzheimer’s disease (5-6). Improved Sex Drive. It's estimated that about 10-40% of women through menopause experience vaginal atrophy – thinning of the walls of the vagina – and dryness, having a significant impact on quality of life through this transitional period. Intravaginal estriol replaces lost estrogen in vaginal membranes and helps alleviate symptoms associated with vaginal atrophy and dryness, with little to no side effects. Since Estriol is the weakest of our three estrogens, and has little affinity for breast and uterine tissue receptors (7), it makes it a safe and effective treatment for almost all women, with as little as 1-2 applications a week. Healthier Bones. Lower estrogen and progesterone levels can lead to an increased risk of developing osteoporosis. By restoring hormone levels, BHRT has been shown to significantly improve bone mineral density, and decrease the occurrence of osteoporosis or hip fractures (8). Other Lifestyle Changes Can Improve Hormonal Health: A healthy lifestyle, including regular exercise, can drastically improve overall health and help balance changing hormones. Reduce or eliminate unnecessary calories from refined sugars, grains, fried foods, and pre-packaged products. Furthermore, limiting refined sugar improves insulin resistance and weight management through fluctuating hormones. Eat more fibre. Fibre not only helps regulate the gut microbiome, which can improve hormonal imbalances, but it also binds to hormonal metabolites and improves their elimination through the bowel. Always talk to your Naturopath about fibre if you are taking oral hormones. Eliminate caffeine and alcohol – both attribute to increasing vasomotor symptoms (aka hot flashes!) Move your body. Getting at least 30 minutes of purposeful activity daily can improve your mood, reduce inflammation, and help maintain a healthy weight. A study in Sports Medicine showed that regular exercise can also help regulate hormones (10). It is important to understand what is causing an imbalance in natural hormone production before embarking on a course of treatment. Oftentimes, simple changes in lifestyle can achieve positive results and provide most – if not all – of the same benefits of hormone replacement therapy. To evaluate your hormonal health and to discuss your treatment options, please contact your Toronto Naturopathic Doctor, Dr. Courtney Holmberg at 647-351-7282 to schedule your appointment today. References: Constantine GD1, Kessler G2, Graham S3, Goldstein SR4. Increased Incidence of Endometrial Cancer Following the Women's Health Initiative: An Assessment of Risk Factors. J Womens Health (Larchmt). 2019 Feb;28(2):237-243. Holtorf K. The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy? Postgrad Med. 2009 Jan;121(1):73-85. Cobin RH, Goodman NF; AACE Reproductive Endocrinology Scientific Committee. American Association of Clinical Endocrinologists and American College of Endocrinology Position Statement on Menopause – 2017 Update.Endocr Pract. 2017 Jul;23(7):869-880. Progesterone for hot flush and night sweat treatment–effectiveness for severe vasomotor symptoms and lack of withdrawal rebound. Prior JC, Hitchcock CL. Gynecol Endocrinol. 2012 Oct;28 Suppl 2:7-11. Epub 2012 Aug 1. PubMed Daniel JM, Witty CF, Rodgers SP. Long-term consequences of estrogens administered in midlife on female cognitive aging. Horm Behav. 2015 Aug;74:77–85. Herrera AY, Hodis HN, Mack WJ, Mather M. Estradiol Therapy After Menopause Mitigates Effects of Stress on Cortisol and Working Memory. J Clin Endocrinol Metab. 2017 Dec 1;102(12):4457–66. Buhling KJ, Eydeler U, Borregaard S, Schlegelmilch R, Suesskind M. Systemic bioavailability of estriol following single and repeated vaginal administration of 0.03 mg estriol containing pessaries. Arzneimittelforschung. 2012 Aug;62(8):378–83. Cano A, Estévez J, Usandizaga R, Gallo JL, Guinot M, Delgado JL, et al. The therapeutic effect of a new ultra low concentration estriol gel formulation (0.005% estriol vaginal gel) on symptoms and signs of postmenopausal vaginal atrophy: results from a pivotal phase III study. Menopause N Y N. 2012 Oct;19(10):1130–9. Sarah Bedell Cook, ND. Bioidentical Hormone Replacement Therapy in Postmenopausal Osteoporosis: Is BHRT the key to prevention? Natural Medicine Journal. Aug 2014 Vol. 6 Issue 81. Schubert MM1, Sabapathy S, Leveritt M, Desbrow B. Acute exercise and hormones related to appetite regulation: a meta-analysis. Sports Med. 2014 Mar;44(3):387-403.