If you suffer from chronic GI or nasal/respiratory problems but have been unable to get a proper diagnosis; or if you have tried antibiotics and antimicrobials to treat your irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), other chronic gut/respiratory problems with little success, it may be helpful to know what a biofilm is and why it may be at the root of your problems. ​ It's estimated that a staggering 23000 people die from antibiotic-resistant infections every year, and the number is increasing. If your previous attempts at getting diagnosed or treating an existing GI condition haven’t been effective, it may be time to consider alternative treatment options to disrupt the biofilms living within you. What Are Biofilms? Biofilms are everywhere. They can essentially exist anywhere where aqueous conditions are present. There can be found in many environments, from underwater to the insides of our mouths (like the plaque on our teeth). They are all generally thought to be formed from microorganisms, like bacteria When the ideal environmental conditions are present, free-floating microorganisms will attach to the surface of a substance and begin to “set up shop,” so to speak. The microbes start to build a protective matrix made up of sugars and proteins called extracellular polymeric substances (EPS). The EPS acts as a protective shell for the bacteria living in the colony, allowing the microbes to share nutrients, replicate, and exchange genomic information to evade destruction (ie antibiotic resistance). There is a strategic advantage for microbes to form a biofilm colony. The colony is usually more resilient to stress and solo microorganisms. The protective matrix helps prevent antimicrobials and other substances from harming the inhabitants of the biofilm while allowing certain microorganisms to go dormant, which makes antibiotics less effective in killing the bacteria. Infectious microbes commonly known to produce biofilms may include Staphylococcus sp., Pseudomonas aeruginosa, Streptococcus sp., Listeria monocytogens, Clostridium sp., N. gonorrhea, and Candida albicans. Growth generally occurs through the layering of microorganisms and the EPS layer, and seeding dispersal. Clumps of cells or individual cells can leave the colony — a process called seeding dispersal — and reattach themselves to new areas of a surface. This can happen for any number of reasons but usually results in there being more than one biofilm colony on any given surface. Biofilm and Human Health It is estimated that up to 80% of chronic illnesses are caused by an abundance of biofilm in the body. Chronic lung infections in cystic fibrosis patients, chronic sinusitis, and inflammatory bowel disease are all caused by different kinds of biofilms within the body. Illnesses associated with biofilms can include: Chronic sinusitis S. aureus skin infection Antibiotic-associated enteritis caused by Clostridium difficile Chronic UTIs Candidiasis Autistic behaviours caused by neurotoxins from Clostridium overgrowth Lyme disease Biofilms make the treatment of chronic illnesses more difficult because they are resistant to antibiotics and antimicrobial treatments. Additionally, if diagnostic testing is looking for a particular bacterial presence, it may not show up on a test until the bacteria has dispersed from the film colony. Indications that You Have a Biofilm Problem Biofilms love the large intestine and upper respiratory pathways because the GI tract is generally moist - a condition that biofilms thrive. Generally, there are not any specific symptoms that indicate the presence of biofilm, but there are some signs that your symptoms are biofilm-related. If you have previously tried to treat your IBS or IBD symptoms with antibiotics or antimicrobials and the symptoms have persisted. For example, confirmed cases of SIBO sometimes do not improve with antimicrobial treatment. This is an indication that biofilms may be to blame. Your symptoms improve with antimicrobial treatment, but they seem to be recurring. This commonly happens with chronic sinusitis – a patient feels great during treatment, but all symptoms return when treatment is discontinued. Though chronic GI or sinusitis symptoms are present, there are minimal to no pathogenic overgrowths or infections evident in stool samples, nasal cultures, or sputum cultures. Natural Biofilm Disruptors Since testing for IBS, IBD, and other GI problems rely on the identification of specific microorganisms, biofilms can make diagnosing and treating your chronic gut symptoms particularly problematic. Biofilms provide a sort of protective shield against detection and prevent traditional treatments from breaking through the EPS barrier to get to the targeted organisms. There are natural ways to disrupt the biofilm in your gut, which can alleviate your symptoms and make testing for particular bacteria easier for your health practitioner. Here are just a few of the natural biofilm disruptors that have been proven to aid in the breaking down of biofilms: Garlic Oregano oil Serrapeptase Alpha lipoic acid Polysaccharide-digesting enzymes like Nattokinase and bromelain N-acetyl-cysteine As always, before beginning any kind of treatment, it is important to work with your healthcare practitioner to determine the best course of action and to ensure biofilm agents pose no harm. To discuss your gut health and treatment options, and to find an approach that’s right for you, call Dr. Courtney Holmberg, ND at 647-351-7282 to schedule a consultation today References: Anwar H, Costerton JW. Enhanced activity of combination of tobramycin and piperacillin for eradication of sessile biofilm cells of Pseudomonas aeruginosa. Antimicrob Agents Chemother 1990;34:1666-71. Bjarnsholt T1. The role of bacterial biofilms in chronic infections. APMIS Suppl. 2013 May;(136):1-51. Centers for Disease Control and Prevention. U.S. Department of Health and Human Services. 2013. Costerton W, Veeh R, Shirtliff M, Pasmore M, Post C, Ehrlich G. The application of biofilm science to the study and control of chronic bacterial infections. J Clin Invest 2003;112:1466-77. Foster TJ, Geoghegan JA, Ganesh VK, Hook M. Adhesion, invasion and evasion: the many functions of the surface proteins of Staphylococcus aureus. Nat Rev Microbiol 2014; 12:49-62. Hoiby N, Bjarnsholt T, Givskov M, Molin S, Ciofu O. Antibiotic resistance of bacterial biofilms. IJAA 2010; 35(4): 322-332. Moskowitz SM, Foster JM, Emerson J, Burns JL. Clinically feasible biofilm susceptibility assay for isolates of Pseudomonas aeruginosa from patients with cystic fibrosis. J ClinMicrobiol 2004;42:1915-22. Zapotoczna M, McCarthy H, Rudkin JK, O'Gara JP, O'Neill E. An essential role for coagulase in Staphylococcus aureus biofilm development reveals new therapeutic possibilities for device-related infections. JID 2015; 212: 1883-1893.

Many health trends come and go, but one dietary trend that has seemed to endure the craze is intermittent fasting. The primary reason intermittent fasting (IF) has remained so popular is that it offers flexibility to fit a busy schedule, and (while I don't typically advise mindless eating as long as you're fasting) it doesn't ultimately demand restricted eating. What is intermittent fasting, and how is it done? Intermittent fasting is defined as a diet regimen that cycles through a period of time in which the body is driven into a catabolic state through fasting, where no significant calorie intake occurs, met with periods of fed states where no calorie restriction occurs. The windows for fasting are typically around 16 hours, met with an 8-hour fed state. Intermittent fasting can be used in a few different ways: Time-restricted feeding: You restrict the time you are allowed to eat to set hours of the day. For example, you eat all of your meals in an 8-hour window, from 9-5 pm. During the window, no calories are restricted, and outside of this window, no calories are consumed. Alternative day fasting: You alternate the days on which you restrict your caloric intake with ones where there are no restrictions. For example, Mon-Wed-Fri you fast for 24 hours/limit calories to 25% of your daily intake, while alternative days have no restrictions Full Day Fast: You only consume water and other liquids for 24 hours1-2 days per week. The most common approach is time-restricted feeding. Now, most guidelines state that the timing of these fed/fasted windows won’t matter – ie a fed state from 9 am – 5 pm will produce the same results as a fed window from 1 pm – 9 pm. We’ll talk about why that’s not always true in a moment. But first, let's look at the research that demonstrates the health benefits of intermittent fasting. Are There Benefits to Intermittent Fasting? Weight Loss: A systematic review of over 40 studies on intermittent fasting has shown it to have benefits on weight loss in the short term, with average weight loss around 9-11 lbs at 10 wks (1). This occurs for two reasons. #1 – during fasting, the body goes into a catabolic state to continually feed the brain. This means that when we run out of bioavailable sugar and glycogen stores, the body will start breaking down our fat as fuel, hence, fat loss. This mechanism typically peaks at about 12-14 hours, with some evidence suggesting the benefit is lost after the 16-hour mark (hence the common 16 hours fasted/8 hours fed approach). #2 - during fasted states, the body increases the production of human growth hormone (HGH), which helps maintain lean muscle mass. Therefore, in catabolic states in the presence of HGH, the body prefers fat breakdown instead of lean muscle mass (again, favouring fat loss). To further avoid muscle loss and promote fat mass loss, I typically recommend incorporating some form of daily exercise and maintaining a high fat/high lean protein diet while using intermittent fasting. Reduced Cancer Risks: The risks for certain types of cancer development and reoccurrence can be lowered through the use of intermittent fasting. Studies have shown higher leptin levels in the body do contribute to the development of certain cancers. Through intermittent fasting, leptin levels can not only be lowered but adiponectin levels can also be increased, which is a hormone that has been shown to be protective of metaplastic cell development. A trial published in JAMA Oncology in 2016 demonstrated that fasting 13 hours or more per night resulted in a statistically significant improvement in glucoregulation and a reduction in the reoccurrence rates of breast cancer (2), making it a simple non-pharmaceutical approach to minimizing breast cancer reoccurrence. Improved Cardiovascular Health: Intermittent fasting helps reduce low-density lipoprotein (LDL) or “bad” cholesterol and triglyceride levels. Having high levels of both LDL cholesterol and triglycerides increase the risks of heart disease, heart attacks, and strokes. Using a combination of intermittent fasting methods and eating a healthy diet can naturally reduce these risks. Better Regulation of Insulin Levels: The amount of sugar people consume in their diets has become a major cause of insulin resistance, which is one of the contributing factors of diabetes. By incorporating fasting methods just a few days each week, Intermittent fasting helps us become more sensitive to insulin, the fat-storage hormone, and leptin, our satiety hormone, ultimately improving sugar metabolism, while reducing insulin resistance. Improved Mental Stability: People who practice intermittent fasting report energy, as well as lower levels of anger, confusion, tension, and stress. Additionally, they found they were less prone to mood swings with longer periods of mood stability throughout their days. This likely has a correlation to better blood sugar stability, as well as improved mitochondrial function. Fasting has been shown to boost the quality of mitochondria (the energy producers of every cell) by speeding the rate at which old and damaged mitochondria are cleared. Where the research falls short: The first shortcoming to intermittent fasting is that when you compare apples to apples, research to date shows that intermittent fasting provides no further long-term benefit over calorie restriction, and calorie restriction provides no long-term benefits in weight loss. In fact, most long-term evidence shows calorie restriction has negative impacts on long-term weight loss. Now let me be clear here – daily calorie deficits are a good thing. Eating the same/slightly less and exercising more could never be a bad thing. However, when we examine some of the major clinical studies conducted on weight loss (the TODAY study, the Women’s Health Initiative study, and the Diabetes Prevention Program), data shows that despite initial weight loss compared to control groups, continuous calorie restriction did not amount to long term changes in weight or body composition. In fact, the members of these trials not only gained back all their weight but also now have to follow a calorie-restricted diet to maintain it. (4,5,6) With this being said, the long-term data for intermittent fasting benefits just simply doesn’t exist yet. Understanding that calorie restriction and intermittent fasting both have underlying catabolic actions call for the need for more long-term studies with follow-ups greater than 1 year would be needed before drawing conclusions about the long-term safety of intermittent fasting on metabolism. The second biggest pitfall to intermittent fasting research is that the majority of it is done in men. No large-scale, long-term follow-up trials have yet to be conducted on female subjects, which is a problem. Numerous trials to date show higher negative sequelae to dietary restrictions in women, such as carbohydrate deprivation inducing under-functioning thyroid in as little as 6 wks, and ketosis caused menstrual dysfunction in 45% of women after 6 months (7). And while we don't have great human trials for intermittent fasting for women, rat trials show significant impacts on reproductive hormones in as little as two weeks following IF (8). This information should be extrapolated with caution when deciding if intermittent fasting is right for you. When should intermittent fasting be avoided? While health benefits from IF exist for many people, the following people should not engage in restrictive dieting without the counsel of a medical professional: Type I Diabetes – while I do use IF in some of my insulin-dependent patients, it is recommended on a case-by-case basis, and with close supervision. Uneducated users can risk hypoglycemic events and severe health risks. Eating disorders that involve unhealthy self-restriction (anorexia, bulimia nervosa, orthorexia) Use of medications that require food intake or result in hypoglycemia Active growth stages, such as infants or adolescents Pregnancy, breastfeeding – there’s just not enough research to confirm its safety in pregnancy, and restrictive dieting during breastfeeding usually leads to decreased milk supply. My general advice remains to assess things on a case-by-case basis to determine if intermittent fasting is right for you, and for how long. Until more research confirms more long-term benefits and conclusive benefits in women, I usually advise sticking to IF 2-3 days a week and maintaining a whole foods, plant-rich diet the rest of the time. To find out if intermittent fasting and which methods are right for you, please feel free to contact Dr. Courtney Holmberg, ND at 647-351-7282 to schedule an appointment today! References: Seimon RV, Roekenes JA, Zibellini J, Zhu B, Gibson AA, Hills AP, Wood RE, King NA, Byrne NM, Sainsbury A. Do intermittent diets provide physiological benefits over continuous diets for weight loss? A systematic review of clinical trials. Mol Cell Endocrinol. 2015 Dec 15;418:153-72 Catherine R. Marinac, BA; Sandahl H. Nelson, MS; Caitlin I. Breen, BS, BA; Sheri J. Hartman, PhD; Loki Natarajan, PhD; John P. Pierce, PhD; Shirley W. Flatt, MS; Dorothy D. Sears, PhD; Ruth E. Patterson, PhD. Prolonged Nightly Fasting and Breast Cancer Prognosis. JAMA Oncol. 2016;2(8):1049-1055. doi:10.1001/jamaoncol.2016.0164 Seimon RV, Roekenes JA, Zibellini J, Zhu B, Gibson AA, Hills AP, Wood RE, King NA, Byrne NM, Sainsbury A. Do intermittent diets provide physiological benefits over continuous diets for weight loss? A systematic review of clinical trials. Mol Cell Endocrinol. 2015 Dec 15;418:153-72 Trepanowski JF, Kroeger CM, Barnosky A, Klempel MC, Bhutani S, Hoddy KK, Gabel K, Freels S, Rigdon J, Rood J, Ravussin E. Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults: A Randomized Clinical Trial. JAMA Internal Medicine. 2017 May 1. Johnstone AM. Fasting–the ultimate diet?. Obesity Reviews. 2007 May 1;8(3):211-22. Harvie M, Howell A. Potential Benefits and Harms of Intermittent Energy Restriction and Intermittent Fasting Amongst Obese, Overweight and Normal Weight Subjects—A Narrative Review of Human and Animal Evidence. Behavioral Sciences. 2017 Jan 19;7(1):4. Mady MA1, Kossoff EH, McGregor AL, Wheless JW, Pyzik PL, Freeman JM. The ketogenic diet: adolescents can do it, too. Epilepsia. 2003 Jun;44(6):847-51. Kumar S, Kaur G (2013) Intermittent Fasting Dietary Restriction Regimen Negatively Influences Reproduction in Young Rats: A Study of Hypothalamo-Hypophysial-Gonadal Axis. PLOS ONE 8(1): e52416. https://doi.org/10.1371/journal.pone.0052416

One of the core principles of functional medicine is to nourish the body and ensure it is getting the appropriate balance of nutrients to stay healthy. Traditionally, this was achieved in a hunter-gather diet by eating colourful whole foods and by practicing “nose-to-tail” eating of meat, which included the consumption of skin, cartilage, marrow, tendons/ligaments, and other parts of the animal that are now typically discarded. Unfortunately, much of this practice has been lost as a result of prepared meats, microwaves, and canned soups over homemade stocks. As a result, our diets have become deprived of an important protein, known as collagen. There is a lot of noise in the health industry lately about collagen supplementation. The concept of supplementing collagen attempts to regain what we’ve lost from our primitive diet, but the question becomes if supplementation has any benefit. Benefits of Collagen I’ll admit that when I first heard about the trend of supplementing collagen, I wasn't on board. It made no sense to me. Collagen is a tissue found in our bodies made from amino acids, vitamin C, etc. So how could supplementing the end product collagen benefit us? But as it turns out, research in mice shows that hydrolyzed collagen peptides (from gelatin) have a 95% absorption rate at 12 hours after intake, and it distributes in the body similar to that of raw amino acids, with the exception of cartilage (1). Collagen was seen to concentrate more than twice as high in cartilaginous tissue than raw amino acids (1), giving collagen some unique benefits. So, I jumped on the bandwagon. Collagen helps reduce joint pain and can aid people suffering from arthritis. Collagen is the primary protein found in the ligaments and tendons that connect joints together. It is also a major component of cartilage, which is a smooth connective tissue that coats our bones and allows for friction free movement. The body naturally produces collagen, yet as we get older, this production gradually decreases. As a result, joint pain can increase. Research shows that athletes who took a hydrolyzed collagen supplement for 24 weeks experienced less pain in their joints at rest and during movement (2), which may help physical performance and decrease joint deterioration. Collagen’s high affinity for cartilage makes it a more likely option for the prevention and management of degenerative arthritis. Collagen helps improve skin, hair, and nail health. The beauty industry has been promoting this benefit of collagen supplements for years. Positive effects gained from using collagen for beauty purposes include a reduction in wrinkles, an increase in skin density, reduced scarring in acne, and improvements in cellulite. A trial using 2.5 g of collagen peptides daily showed a significant decrease in the degree of cellulite and a reduced skin waviness on thighs in both normal-weight and overweight women (3). Another trial showed positive effects on wrinkles and dermal matrix synthesis with the use of collagen in just 8 weeks of use (4). Collagen can help improve digestion, gut integrity, and detoxification. I would have to argue that the most impactful benefit of collagen comes from its benefits on the gut. A healthy digestive tract contains a layer of tightly bound epithelial cells and a diverse colonization of microbes. However, microbial dysbiosis, refined/processed diets, and environmental stressors all have negative impacts on the integrity of your gut membrane and lead to increased permeability commonly known as “leaky gut” (5). Intestinal permeability allows for foods and other toxins to leak into our bloodstream, creating systemic symptoms correlated to food intolerances, autoimmunity, acne, fatigue & brain fog, eczema, etc. A diet high in collagen has numerous benefits for the gut and detox organs like the liver. Gelatin, which is formed from hydrolyzed collagen, helps reinforce the mucous layer of our guts and reduces the impacts of inflammatory endotoxins released from gut microbes (6,7). This may have profound benefits for those with Crohn’s/Colitis. Glycine and glutamine (amino acids found in collagen) have been shown to protect against gastric ulcers and strengthen the integrity of the gut mucosa (8,9). Taking collagen for its glycine has also been shown to help regulate the products of stomach acid and bile, which may help in cases of acid reflux. It also helps promote liver detoxification. Glycine stimulates the production of glutathione, which is a master antioxidant in the liver’s detox process (10), which has been shown to improve fatty liver disease and protect cells against free radical damage. As you can see, there are several benefits you can gain by adding collagen to your diet. How to get collagen Bone broth: But before we get into supplementation, remember that you can get collagen in your diet without the fancy powders and packaging. The most effective way is through bone broth soup, which is a common recommendation in functional medicine these days due to its rich collagen/gelatin content. I typically advise 250 ml of bone broth daily. Here’s a recipe to make your own bone broth. Collagen Powders: You can also get collagen from powdered supplements. Here are some important things to know when choosing a collagen supplement: Not all collagens are equal. Different bones contain different collagens. Beef hide is rich in collagen I & III, whereas chicken sources are rich in collagen II. Marine sources are available for vegetarian/vegan patients. Make sure to talk to your ND to ensure the collagen you are taking is right for your concerns. Check the quality and source of the collagen powder. It should be clear and tasteless when dissolved in water, should not contain fillers and additives, and should be from grass-fed, pasture-raised animals Make sure it's hydrolyzed – only hydrolyzed collagen peptides will convert to gelatin in the body, which is what we reap most of the benefits from. Before you start taking collagen, it is highly recommended you speak to a qualified naturopath, like Dr. Courtney Holmberg to determine if collagen would be safe and appropriate for your own personal health and well-being. Book an appointment online or call 647-351-7282 today! References: Steffen Oesser, Milan Adam, Wilfried Babel and Jurgen Seifert. Oral Administration of 14C Labeled Gelatin Hydrolysate Leads to an Accumulation of Radioactivity in Cartilage of Mice (C57/BL). The Journal Of Nutrition. 26 January 1999. P 1891-95. Kristine L. Clark et al. 24-Week study on the use of collagen hydrolysate as a dietary supplement in athletes with activity-related joint pain.Current Medical Research and Opinion Accepted 29 Feb 2008, Published online: 15 Apr 2008. P 1485-1496. Schunck M, Zague V, Oesser S, Proksch E. Dietary Supplementation with Specific Collagen Peptides Has a Body Mass Index-Dependent Beneficial Effect on Cellulite Morphology.J Med Food. 2015 Dec;18(12):1340-8. doi: 10.1089/jmf.2015.0022. Epub 2015 Nov 12. Proksch E1, Schunck M, Zague V, Segger D, Degwert J, Oesser S. Oral intake of specific bioactive collagen peptides reduces skin wrinkles and increases dermal matrix synthesis. Skin Pharmacol Physiol. 2014;27(3):113-9. doi: 10.1159/000355523. Epub 2013 Dec 24. Christian R. H. Raetz and Chris Whitfield. Lipopolysaccharide Endotoxins. Annual Review of Biochemistry. July 2002. Vol. 71:635-700 Franco Scaldaferri et al. Gelatin tannate ameliorates acute colitis in mice by reinforcing mucus layer and modulating gut microbiota composition: Emerging role for ‘gut barrier protectors’ in IBD? United European Gastroenterol J. 2014 Apr; 2(2): 113–122. Frasca, Venera Cardile, Carmelo Puglia, Claudia Bonina, and Francesco Bonina. Gelatin tannate reduces the proinflammatory effects of lipopolysaccharide in human intestinal epithelial cells. Clin Exp Gastroenterol. 2012; 5: 61–67. PMCID: PMC3358810 Wang et al. Glutamine and intestinal barrier function. October 2015, Volume 47, Issue 10, pp 2143–2154 Tariq M, Al Moutaery AR. Studies on the antisecretory, gastric anti-ulcer and cytoprotective properties of glycine. Research Communications in Molecular Pathology and Pharmacology [01 Aug 1997, 97(2):185-198] Guoyao Wu, Yun-Zhong Fang, Sheng Yang, Joanne R. Lupton, Nancy D. Turner; Glutathione Metabolism and Its Implications for Health, The Journal of Nutrition, Volume 134, Issue 3, 1 March 2004, Pages 489–492

There is a common misperception about progesterone (naturally occurring hormone) and progestin (the synthetic version) — namely that they are essentially identical. “Progesterone” and “progestin” are used interchangeably so often that patients may inadvertently think of them as one and the same, and put themselves at risk for health issues by not being aware that they are not, in fact, synonymous. So what is the difference between progesterone and progestin? The answer may surprise you. What is progesterone? Progesterone is a naturally occurring hormone that functions primarily to regulate reproductive processes. It is produced by the adrenal glands and ovaries or testes, and by the placenta in pregnant women. In women, progesterone is responsible for preparing the uterus for the implantation of an egg and maintaining the lining of the uterus — the endometrium — during pregnancy. In addition to providing reproductive support, progesterone has other benefits, including: Helping to protect against the development of fibrocystic breast tissue — and may help protect against developing certain types of breast cancer. Decreasing the risk of developing ovarian and uterine cancers by balancing estrogen. Helping to normalize blood clotting Being a coronary vasodilator. Restoring libido. Balancing estrogen and testosterone. Improving brain metabolism by boosting the function of mitochondria. What is progestin? Progestin is a general-use term to describe a synthetic analog that closely resembles progesterone and is used to perform similar functions as progesterone. However, progestins' have been modified at a cellular level — primarily to ensure patentability — and are not bioidentical to naturally occurring progesterone. In fact, progestins' are structurally different from progesterone and more closely resemble testosterone. Progestins are used widely in contraceptive pills/injections/IUDs, fertility drugs, and hormone replacement drugs. Despite the prevalence of their use, progestins' have many side effects, including: Causing menstrual irregularities, such as amenorrhea (the absence of regular menstruation) or menorrhagia (excessive or prolonged bleeding during menstruation). Increasing the risk of development of breast cancer than the use of estrogen alone – a 16,608 women trial involving women who had a full hysterectomy showed increased rates of developing breast cancer when taking progestin with estrogen (1 in 12) vs estrogen alone (1 in 99) at 2 years of use (1). Causing migraine headaches (2). Decreasing bone density. Increased risk of thrombotic disorders, like deep vein thrombosis and blood clots. Increased body fat % during use (3). Increasing the risk of the development of dementia. What are progestins used for and why are they used so often? Progestins are generally prescribed as part of a contraceptive or hormone replacement regimen. Progestins are used instead of progesterone because progesterone is not a contraceptive hormone. Progestin impedes or inhibits the body’s ability to ovulate, and hence become pregnant. Progestin-only contraception, such as the mini-pill or an implant, prevents the ovaries from releasing an egg and thickens the mucus at the opening of the cervix which prevents sperm from entering the uterus. Women may require hormone replacement therapy for a number of reasons, including hysterectomy or menopause. When the ovaries no longer produce estrogen, hormone replacement therapy is often recommended to ease menopausal symptoms. However, estrogen-only hormone therapy increases the risk of the development of increased abnormal endometrial growth, so a combination of estrogen and progestin is often used. Progesterone or progestin — what you need to know Structurally, progesterone and progestin are completely different. In fact, there is a growing body of evidence that progestins do not always act like progesterone and do not always affect the targeted tissues the way progesterone would. While progestin may behave similarly to progesterone, progestin reacts differently with the progesterone receptors in the body. If you are experiencing a progesterone deficiency and are in need of hormone replacement therapy, your better option may be to use bioidentical progesterone. Bioidentical estrogen and progesterone may pose lowers risks of developing breast cancer than their synthetic counterparts (4). Bioidentical progesterone is lab-made but is an exact copy of the body’s naturally occurring progesterone. If you wish to discuss hormone replacement therapy options further, it's best to speak with a licensed professional who is able to prescribe bioidentical hormones. Please feel free to contact Toronto Naturopathic Doctor, Dr. Courtney Holmberg at 647-351-7282 to schedule a consultation today! References: https://academic.oup.com/jcem/article/86/1/16/2841064 https://www.webmd.com/sex/birth-control/mini-pill#2 https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0014869/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4960754/

Insulin Resistance: Is There a Link to Dairy Products? A considerable amount of research has been aimed at isolating the contributing factors in the development of insulin resistance and looks to discover better ways of controlling and preventing the onset of this disorder. We already know that diet plays a significant role. In fact, diet is the leading cause of type 2 diabetes: the outcome of unmanaged insulin resistance. Resistance to insulin can also occur in other metabolic/endocrine disorders, such as polycystic ovarian syndrome (PCOS) which affects up to 12% of the female population in North America. In more recent years, an increasing body of evidence is finding that dairy consumption has an adverse effect on insulin production, and may, in fact, be contributing to insulin resistance. What the studies are finding: • A 2015 Brigham Young University study found “…a significant relationship between dairy consumption and reduced insulin sensitivity… suggesting that higher intakes of dairy products may be associated with greater insulin resistance." [1] • Research conducted in the Netherlands also found that there was a significantly higher fasting glucose level found in participants who consumed dairy products. [2] • A more recent Iranian study found that the branched-chain amino acids found in dairy products may be at the root of increased insulin resistance. [3] What does insulin do? In order to understand what insulin does, we need to examine why we need it. Insulin regulates our body’s glucose supply. Glucose is our body’s most readily available source of energy and is derived from the foods we eat. Certain foods, like simple carbohydrates and refined sugar, expose our bodies to a high amount of available glucose all at once. This glucose spike in our bloodstream triggers the release of insulin, which acts as a key to unlocking the cellular absorption of this glucose. Whatever glucose that isn’t turned into energy within the cell is stored in our livers and muscles as glycogen, and the overflow is converted to adipose tissue, also known as fat. When a person develops insulin resistance, the cells in his or her body are essentially resisting the “insulin instruction” to absorb glucose. The cells stay closed and glucose builds up in the blood. To counter the excess glucose in the bloodstream, the pancreas – the organ responsible for producing insulin – makes more and more insulin. However, over time, the pancreas can wear out. When this happens, the resulting disorder is type 2 diabetes. Additionally, higher insulin resistance leads to higher amounts of unused glucose, and without depleting your glycogen stores (most commonly through exercise and fasting), the excess glucose has nowhere to go other than to be converted to fat. Dairy and its effect on insulin Dairy is still often considered a low-glycemic food source. In other words, it is thought that low-fat dairy is safe for individuals with insulin resistance or diabetes to consume in moderation. However, as we are discovering, in people experiencing insulin resistance – whose pancreas' are already working overtime – the insulin-producing properties of certain properties in dairy, like whey and carbohydrates, can have an adverse effect on insulin sensitivity. Specific amino acids found in dairy products can cause insulin spikes. Certain foods, like yogurt, kefir, and milk (particularly the low-fat varieties), which are higher in milk proteins, seem to contain higher amounts of insulinogenic amino acids. Higher-fat dairy products, like butter or good-quality aged cheese, appear to contain fewer problematic proteins and sugar. Everything in moderation To avoid insulin spikes, consume dairy in moderation and skip the low-fat varieties. There are many readily-available alternate sources for the beneficial components found in dairy products: • Kale, broccoli, and spinach are excellent sources of calcium; broccoli, in particular, is also high in fibre. • Substitute kombucha or coconut kefir for yogurt or milk-based kefir for good sources of probiotics. • Wild-caught fish, like salmon, or shiitake mushrooms are healthful vitamin D options. There are many factors that can contribute to insulin resistance – with diet being the main component. In order to effectively halt or reverse the effects of insulin resistance, or to answer your questions, please feel free to contact Toronto Naturopathic Doctor, Dr. Courtney Holmberg at 647-351-7282 to schedule a consultation today! Visit us References: 1. https://www.hindawi.com/journals/jdr/2015/206959/ 2. https://academic.oup.com/ajcn/article/85/4/989/4649004 3. https://onlinelibrary.wiley.com/doi/abs/10.1111/1753-0407.12639

I'm reading a great book right now that explains the evolution of the human species, and how we as a species have developed from foragers (on the move all the time) to farmers (settled but still labouring), to now being's that spend the majority of their day slaving away behind a desk. And while the growth of homo sapiens' cognitive abilities has reshaped our cultural, economic and agricultural world immensely, our bodies have unfortunately not really evolved with us. Despite fewer injuries and death, arthritis, back pain, and obesity-related health concerns are at an all-time high. Why is this, and what factors are involved in this change? Any extended periods of time spent sitting, such as behind a desk, in a car, or in front of a screen can be harmful. A meta-analysis of over 12 studies determined that more than 8 hours/d of sitting with no physical activity had the same risk of death as obesity and smoking. However, these effects can be counteracted with 60-75 mins of moderate to high-intensity exercise daily. Unfortunately, not everyone has the capability to sustain that level of exercise, so other solutions are needed to maintain a healthy lifestyle and offset seated hours. While studies are still needed to understand the benefits of offsetting prolonged sitting, some functional solutions exist to minimize the time you spend on your bottom. First off, stand instead of sit. Almost all work that can be done at a seated desk, can also be done at a standing one. The ErgoConvert from AnthroDesk has been a game changer for me. Emailing and charting take up a large part of my day, and this sturdy, well constructed, electronically convertible standing desk is cutting my seated hours down sustainably. The electronic controls make it easy to convert back and forth as needed, and adjustable for multiple users in our home. Furthermore, there is a computer screen mount to make the setup even more ergonomic. ​ Secondly, Get up and move. Take a break from sitting every 30 mins or so. Place the water cooler and fax machine at the opposite end of the office to encourage more movement and less time seated. ​ ​ Take a stroll at lunch. Instead of sitting in the lunchroom with colleagues, catch up over a stroll around the block. Regular breaks, lunchtime exercise, and fresh air/daylight have been proven to increase productivity, boost office morale, and decrease sick days away from work. Watch TV in front of a treadmill. Position a treadmill or stationary bike in the eyesight of your television and walk while you catch up on your favourite television shows in the evening. Lastly, stand even more. Walk around while taking a phone call. Stand while you do the laundry. Stand around a bar-height table while you catch up with friends. The benefits of movement, even when leisurely, can significantly minimize the time we spend sitting (studies show on average up to a 33% decrease) and positively impact our health and lifestyles. Remember, the human body is built to move, and less time sitting will likely lead to better energy and maybe even weight loss. One thing to note - always set up your standing desk in an ergonomic way. Your elbows should be at a 90-degree angle, you should not be leaning forward or reaching for your keyboard, and your screen should be positioned at eye level. Place a sticky note on the corner of your screen to ensure you remind yourself to maintain an even weight distribution and not favour one leg while standing to prevent hip and back problems. Sincerely,​ Dr. H

The health benefits from the diversity and population of the microbiome in our gut have been well documented, ranging from digestive relief in irritable bowel syndrome to predicting and preventing the onset of asthma, dermatitis, and even breast cancer (1). There has also been a growing trend towards probiotic-based foods like kimchi, sauerkraut, yogurt, and kombucha. And while most of us are now aware of the fact that probiotics support a healthy gut, it’s important to remember that it is not a “one-size-fits-all” approach. ​ What are probiotics, and when should I use them? Probiotics are live organisms -- typically bacteria or yeast -- that stimulate the growth of beneficial microorganisms that make up our intestinal flora. Regular consumption of probiotics creates a healthy microbiome which is essential to gut and overall health. ​ The most common time to take a probiotic is during + following antibiotic use. Antibiotics degrade the population of our good flora, and therefore they require replacement. Some antibiotics, such as amoxicillin, ciprofloxacin, etc, have also been shown to allow for opportunistic infections from candida, or yeast. The primary concern for antibiotic use is ultimately the results of dysbiosis, which is a severe imbalance in desirable vs undesirable bacteria in our gut. Some of the other benefits of probiotic use can include: • Boosting your immune system • Improving immune dysfunction, such as in seasonal allergies, eczema, asthma, etc. • Improved digestive function • Increased absorption of nutrients, and elimination of waste • Fighting pathogens There are many readily-available sources of probiotics, from supplements to food. Supplements usually only contain single strains of bacteria, sometimes in isolation, or other times multi-strain. Unfortunately, some evidence suggests capsulated probiotics don't populate our gut long-term. If you are looking for ways to increase your probiotics consumption, it may be best to start with probiotic-rich foods like some of these: • Yogurt (make sure to choose a yogurt with live or active cultures) • Kefir • Sauerkraut • Kombucha • Miso What to expect when you are taking probiotics? Most people can tolerate probiotics fairly well; however, the most common side effects are a temporary increase in gas and bloating, constipation, and thirst. The cause of these side effects in some people is not entirely known, but they usually subside after a few weeks of continued use. And while there may be several health benefits associated with taking probiotics, there are some people who should always seek advice before starting a probiotic. These people include individuals on immunosuppressive drugs, those with a compromised immune system, or a serious illness which predisposes them to more severe complications. Can probiotics make you feel worse? Our intestinal tract is a veritable colony of microorganisms. There are trillions of these little guys inhabiting our GI tracts and the exact combination and strains make for an incredibly complex interaction within us. When we introduce different species into the mix, it can cause a temporary impact on our intestinal environment. The equilibrium that existed previously has been thrown off balance and needs to readjust. Once the new – and hopefully more beneficial – balance establishes itself, the symptoms should stop. One primary instance where probiotics may persistently make symptoms worse is in cases of small intestinal bacterial overgrowth (SIBO). Since the root of this problem is already an overgrowth of bacteria in the wrong place (the small intestine), adding more bacteria to the mix can often aggravate symptoms. SIBO symptoms look a lot like IBS, which is why it is important to speak to your naturopath before starting a probiotic. You should always introduce probiotics slowly – a process called “titrating” – and increase to a full dose gradually. The Must-Knows when choosing a probiotic #1: Not every probiotic is the same. L rhamnosus GG has been shown to decrease the incidence of asthma and allergies in children, L. acidophilus is helpful in preventing repeat yeast infections, and B. lactis has been shown in clinical trials to improve intestinal dysbiosis and IBS symptoms. Taking an over-the-counter probiotic is useless unless it contains the proper strains indicated for your concern. This is where you want to speak to your ND to choose a probiotic that's right for you. #2: Most probiotics cannot survive at room temperature. Multiple consumer reports have confirmed that many probiotics taken off the shelf are no longer alive, and therefore relatively unhelpful. Many strains of probiotics must be kept at < 8 degrees C or they will degrade at roughly about 4% per day. Meanwhile, some strains of probiotics are completely safe at room temperature, such as S. boulardii, which makes it great for travel. Do your research before buying strains off the shelf, or stick to probiotics found in the refrigeration section of your health food store. #3: Quantity matters. Some probiotics will claim to be over 50 billion bacteria per capsule, but in fact, contain less than 5 million colony-forming units of the desired strains (this is very common with l. acidophilus). Many clinical trials show no benefit to probiotic strains until they reach a certain quantity of exposure. Always read the label, which breaks down the strains and counts of each colony. #4: Watch for fillers and Prebiotics. For those searching for probiotics for gas, bloating, IBS, IBD, etc, if a probiotic makes you feel worse, it may not be the actual bacteria. Many capsulated probiotics contain prebiotics such as inulin, pectin, potato or tapioca starches, maltodextrin, and/or fructooligosaccharides (FOS), which in and of themselves can create gas and bloating. Many are also washed in dairy, which can be a problem for those sensitive to dairy products. When is it time to call the doctor? Once starting a probiotic, if you haven’t presented with an exacerbation of symptoms (suggesting potential overgrowth of bacteria in your gut), no infectious pathogens are present, and your symptoms are on the mild end of the spectrum, you can probably keep taking it. Eventually, your GI tract will settle back down to normal. If you find that you cannot tolerate probiotics, it could be a sign of gut pathogens like parasites or bacterial infections, as well as potential overgrowths. Because each of these issues requires a different treatment approach, it is important to have functional GI testing done to work out exactly the root cause of the problem. If you want further help or wish to discuss ways to support optimal gut health, please feel free to contact Toronto Naturopathic Doctor, Dr. Courtney Holmberg at 647-351-7282 to schedule a consultation today!

Eating a diet full of fruits, vegetables, lean proteins and whole grains is just generally good for us, but as it turns out, eating a high plant-based diet may help lower your risk for developing many chronic health conditions, including cancer. While no single food or combination of foods can eradicate cancer, studies have shown that the combination of compounds found in certain foods — when part of a healthy diet — can help significantly increase your anti-oxidant intake and decrease your risk of developing a number of disorders, including cancer. ​ The phytochemical compounds found in fruits, vegetables, and legumes, along with antioxidants and a host of vitamins and minerals, all work in conjunction to provide cellular repair. Foods alone cannot cure cancer, but a healthy diet can go a long way toward minimizing your risk. According to the American Institute for Cancer Research, “In laboratory studies, many individual minerals, vitamins, and phytochemicals demonstrate anti-cancer effects. Evidence suggests that it is the synergy of compounds in the overall diet that offers the strongest cancer protection.”[1] In other words, make sure that your plate is colourful and is part of a well-balanced and healthy diet. While many foods can play a key role in an anti-oxidant diet, here are a few suggestions to make sure you have on hand: Apples It’s true what they say: an apple a day keeps the doctor away. Apples are action packed full of vitamin C and fibre, not to mention phytochemicals quercetin, flavonoids, triterpenoids. They are a very high FODMAP food, so use them with caution if you have irritable bowel syndrome, or have been diagnosed with SIBO. Blueberries Go ahead and throw an extra handful of these berries on your morning chia seed pudding (which is also remarkably high in omega-3 fatty acids). Blueberries are full of vitamins C and K, manganese, and are a great source of dietary fiber. Blueberries are also full of antioxidants like anthocyanin, elegiac acid, and resveratrol (to name a few). Coffee Many of us start our days with a cup of coffee, but as it turns out, we also intake a dose of antioxidants. While not all coffees are created equal, they mostly are a good source of riboflavin and concentrated phytochemicals. Always purchase organic coffee to minimize your chemical exposure, and try to avoid pods that are run through the plastic casing (heated plastics are linked to hormone disruption and carcinoma – not the mention they’re terrible for our environment). Furthermore, if you’re choosing decaf, ensure it's Swiss water is processed. Most decaffeinating processed require copious amounts of chemicals to remove the caffeine. Cranberries An essential side dish on many holiday tables and the go-to juice for urinary tract infection relief, cranberries are an excellent source of vitamin C and dietary fiber. Additionally, cranberries are full of flavonoids and ursolic, benzoic, and hydroxycinnamic acids. Garlic This member of the Allium group of vegetables — which also contains shallots, onions, and leeks — is a pantry staple enjoyed around the world. Garlic is well-known for its antimicrobial and anti-inflammatory properties but is getting a fair amount of scrutiny for its cancer-fighting attributes as well. Garlic contains saponins, allicin, and inulin. Dark Leafy Greens Leafy greens like spinach, kale, and Swiss chard are great sources of dietary fiber and iron — and they make a wonderful base for tossed salads, too. But these veggies also contain carotenoids, saponins, and flavonoids which help flush free radicals from the body. When making your grocery list, make sure to include legumes, mushrooms, cherries, and carrots— all proven to have anti-carcinogenic components. Furthermore, always ensure to check the clean fifteen/dirty dozen list to ensure you’re minimizing your risk of pesticide and inorganic exposures. For more information about improving your health or to discuss naturopathic health treatments and services, please feel free to contact Dr. Courtney Holmberg, ND at 647-351-7282 to schedule an appointment today! ​References: [1] http://www.aicr.org/foods-that-fight-cancer/

Bone broth is a rich source of nutrients. It contains protein, cartilage, gelatin, and minerals, especially calcium. It’s easy for our body to digest, tastes delicious and fills a home with an aroma of goodness while cooking. Bone broth is inherently calming, consoling, and restorative to our energy and spirit. The gelatin in bone broth also has been shown to have numerous benefits on the cartilage in our joints, the integrity of our gut membrane, the detoxification of our livers, and the health of our skin! ​ BASIC BONE BROTH MAKING Bones - poultry, fish, shellfish, beef or lamb - cooked bones from a previous meal, with or without skin or meat - raw bones, with or without skin and meat (can be browned first for flavour) ​- use a whole carcass or just parts (good choices include feet, ribs, necks and knuckles) Water - cold enough to just cover the bones or 2 cups water per 1 pound bones Vinegar - any kind a splash (1-2 tablespoons), or substitute lemon juice for vinegar Vegetables (optional) – skins, ends and tops or entire veggie traditional choices include celery, carrots, onions, garlic and parsley, but any will do Combine bones, water and vinegar in a pot, bring to a boil, remove any scum that has risen to the top and reduce heat. Simmer 6 - 48 hrs in a pot or crock pot for chicken, 12 –72 hrs for beef, the longer the better (24 hrs is best). To reduce cooking time, you may smash or cut bones into small pieces first. If desired, add vegetables in the last 30 minutes of cooking (or at any point as convenience dictates). Strain through a colander and discard the bones. If uncooked meat was used to start with, you may reserve the meat for soup or salads. If you wish to remove the fat for use in gravy, use a gravy separator while the broth is warm, or skim the fat off the top once refrigerated. Cold broth will gel when sufficient gelatin is present. Broth may be frozen for months, or kept in the refrigerator for about 5 days. TO USE Soup - Make soup by adding vegetables, beans, grains or meat to broth. Briefly cook vegetables and meat with oil or butter in the bottom of a stockpot (optional- 5 minutes). Add broth and grains or previously soaked beans and simmer till all is cooked through (time will vary with ingredients but count on a minimum of 20 minutes). Season with salt and pepper or other spices. Cooking Liquid - Use broth in place of water to steam veggies or cook rice, beans or other grains. Place a steamer basket of veggies over broth or add grains or beans directly to it in the proper ratio. Simmer for the instructed time. You may thicken the veggie steaming broth, as below, to use as gravy. Gravy - Make gravy to put on vegetables, meat or biscuits. Put fat (removed from the broth, or use butter) in a skillet. Add any type of flour, one tablespoon at a time and stir constantly till browned. Whisk in broth and cook till thickened. Add salt and pepper to taste. Tea - Don’t forget you can just add salt and sip broth like tea. This is especially nice in the winter months or if you’re feeling sick. Since broth is simultaneously energizing and calming, it can take the place of morning coffee, afternoon tea, or evening nightcap. Try it in a thermos and sip it throughout the day. Of course, the most traditional use for seasoned broth is as a first course, to enhance the digestion of any meal to come. I typically advise 250 ml of bone broth daily in active treatment plans for autoimmune conditions, inflammatory bowel disease, leaky gut, acne, arthritis, etc, and a few servings a week for general health. However, always ensure to speak to your Naturopathic Doctor before starting any therapy to make sure it's right for you. References: Excerpted from Traditional Bone Broth in Modern Health and Disease by Dr. Allison Siebecker, in the Townsend Letter for Doctors and Patients Feb/March 2005 #259/260 p74. For the full article see: http://www.townsendletter.com/FebMarch2005/broth0205.htm

If you are experiencing blood pressure issues, you may have heard that reducing your salt intake is one of the best dietary changes you can make to help get your blood pressure under control. For years, the prevailing wisdom touted by major medical organizations is that significantly reducing sodium intake will improve blood pressure and reduce the risk of stroke or heart attack. Your doctor may have told you to keep your sodium intake under 1800 mg/d if you have a history or are dealing with cardiovascular disease. But that recommendation may be misguided, and low-sodium diets may actually do more harm than good. ​Why Does Salt Get Such a Bad Rap? Over a century ago, French scientists found a correlation between a high salt diet and high blood pressure in six of their patients. The findings were debunked just a short three years later, but the belief that salt was bad lingered. A half-century later and Dr. Lewis Dahl conducted a study on rats that were bred to have differing susceptibility to developing hypertension. Dahl induced hypertension in the rats by feeding them a high salt diet – 500 grams of sodium per day! The rats – unsurprisingly – developed hypertension, quickly. By reducing their sodium intake, Dahl was able to demonstrate that there was a link between hypertension and salt intake and that by decreasing sodium in the diet, hypertensive symptoms were abated. But we must remember, correlation findings do not necessarily equal causal relationships. While there is no dispute that Dr. Dahl’s research was well-intended, it was significantly flawed. For instance, the average American’s salt intake is roughly 8.5 grams of salt per day (compared to the 500 g given to the rats in the study). Furthermore, hundreds of studies conducted since Dahl’s work have demonstrably shown that reducing sodium intake alone does not significantly relieve hypertension. In May 2011, research published in the Journal of the American Medical Association reported that “the less sodium that the study subjects excreted in their urine – an excellent measure of prior consumption – the greater their risk was of dying from heart disease.”1, 2 Therefore the desired out, in this case preventing heart disease, is not successfully achieved by the intervention, which in this case is sodium restriction. Dahl’s study only marginally touched on the genetic component that may lead to developing high blood pressure. Certain segments of the general population are predisposed to being hypersensitive to salt; however, genetics is only one factor. Hypertension is a symptom -- not a disease itself – and is generally a symptom of a much larger health problem. Obesity, diabetes, and high cholesterol are all factors that contribute to high blood pressure. The Problem with Sodium Restriction Salt is our main supply of sodium – a mineral that our bodies need for everything from maintaining a healthy balance between intracellular and extracellular fluid to supporting electrical currents across cell membranes. Reducing our salt intake isn’t necessarily a bad idea, except when it is. Simply cutting salt out of your diet completely can actually cause more harm than not cutting it out at all. When salt intake is reduced, your body responds by releasing aldosterone and renin which increase blood pressure. If the sodium levels in your blood are too low, you could develop hyponatremia – a condition that causes the water levels in your blood to rise and the cells to swell. Being Heart Healthy is a Multi-Pronged Approach Elevated blood pressure is a problem that requires a holistic treatment solution. Simply reducing your salt intake is not enough, and arguably ineffective at preventing the real problem: a heart attack. A low-carb, low-sugar diet, along with regular exercise, will reduce blood pressure and improve your overall health significantly. Exercise and diet are important components in getting you back to health. If you are worried about your blood pressure or looking for ways to improve your cardiovascular health, please feel free to contact Toronto Naturopathic Doctor, Dr. Courtney Holmberg at 647-351-7282 to schedule a consultation today! Sources: 1. https://www.scientificamerican.com/article/its-time-to-end-the-war-on-salt/ 2. https://jamanetwork.com/journals/jama/fullarticle/899663

Our bodies require the right nutrition and nutrients to function correctly. When we do not get the proper intake of these things, different functions and responses stop working correctly. Not only does maintaining the right levels of nutrients help strengthen the body’s immune system, but it can also reduce the risks of autoimmune disease. Autoimmune disease is a category of conditions classified by a dysfunction in the adaptive immune response, where the body’s immune cells have decided to target its own tissue. It suggested that autoimmunity may be triggered by viral infections, dysbiosis, chronic stress, vaccines, or occupational/environmental exposures, but the full mechanism of action still remains unknown. In response to triggers, the immune system begins to treat healthy tissues as invaders and attacks them. Essential nutrients can help restore balance to the immune system, as well as repair the tissues it damaged. It may also help prevent these conditions from occurring. Six nutrients people with autoimmune diseases seem to lack include: 1. B Vitamins All of the B vitamins serve important purposes inside our bodies including: Supports Immune Functions Promotes Cell Production Provides Energy Controls Hormone Levels Helps Regulate Moods Improves Digestion Improve Circulation Controls Nerve Response Helps Us Sleep For example, the B vitamin that helps with the production of white blood cells, the ones the immune system uses to fight infections, is B12. If your body lacks this nutrient, it will have fewer white blood cells to fight infections and regulate itself. 2. Vitamin D Our bodies naturally produce Vitamin D from exposure to sunlight. However, most people do not receive enough sun exposure to produce sufficient levels of this important vitamin. Interestingly enough, vitamin D has improperly been named a vitamin, and functions more like a hormone in the body. It helps teach the T-cells how to distinguish between invaders, like viral and bacterial infections, as well as cells that are identified as “self”. As such, it helps prevent the immune system from attacking itself. 3. Zinc Zinc helps support multiple components of our body's immune systems. It works at multiple layers from the skin cells to our lymphocytes. Zinc also works alongside B12 in promoting the cell production of white blood cells. 4. Omega 3 Fatty Acids Most people’s diets do not have sufficient Omega 3 fatty acids anymore, since our foods have higher levels of polyunsaturated and saturated oils in them. Omega 3 is a healthy animal fat found in fish and other foods like nuts and seeds. It helps support the absorption and utilization of B vitamins by the cells and promotes the production of appropriate antibodies and short-term inflammatory prostaglandins. 5. Magnesium Magnesium is a critical mineral for everyday bodily function. Magnesium levels can quickly be depleted from eating diets high in sugars and from high levels of stress. Reduced magnesium levels have been found to result in more pro-inflammatory cytokines being produced, which has an underlying correlation to autoimmune disease. 6. Selenium Selenium helps regulate thyroid functions as well as immune responses. Proper levels of selenium help reduce thyroid antibodies and reduce the risks of autoimmune disease. To help prevent or reduce the risks of autoimmune disease you need to make sure you are getting these six essential nutrients every day. Also take note that individuals currently suffering from digestive autoimmune conditions, such as Crohn’s, ulcerative colitis, and celiac disease may be experiencing impaired nutrient absorption, making appropriate doses of these critical nutrients through food and supplementation every more important. ​ For more information about naturopathic therapies for autoimmune disease or to find out what nutrient deficiencies you have, please feel free to contact Dr. Courtney Holmberg, ND at 647-351-7282 to schedule a consultation appointment today!

​Pain is something we’re all familiar with. It presents in a variety of different ways, and with a variety of characteristics. And while pain may have a very physical manifestation, it is acknowledged to be a complex physiological and psychological phenomenon. The reaction to pain is highly subjective and is influenced by a variety of factors. We know that actual nociception (the sensory nervous system’s response to harmful stimuli), is at least partially controlled by psychological, social, and situational factors. Furthermore, the perception of the intensity of pain differs from person to person. Despite these factors, all pain is typically managed the same way. Taking an over-the-counter pain reliever every once in a while, like Aleve or Tylenol, for rapid relief is okay. However, most don't know that there is an upper limit to the use of painkillers, and taking them more than the recommended amount may actually cause rebound headaches. Ibuprofen and Naproxen (Advil/Aleve) should be used at most 10 days/month, and Acetaminophen (Tylenol) no more than 15 days/month. Pain relievers are not intended for long-term relief, and far too often the underlying medical cause for the pain succumbs to self-medicated rather than being addressed. Contrary to what you might believe, over-the-counter pain relievers will not work for every type of pain we might experience. Furthermore, long-term use of NSAIDS has been shown to increase risks for heart disease, hearing, inflammatory bowel disease, and kidney function. NSAIDs, especially at high doses, have been shown to increase blood pressure, as well as increased the risk for heart attack and stroke. Aside from over-the-counter pain relievers, there are a number of other natural ways to combat pain, depending on the underlying causes and symptoms one is experiencing. Some of the more common natural ways to treat pain include: ​ Meditation – High levels of stress can lead to more muscle tension, as well as trigger headaches, reduce immune responses, and cause various body aches and pain. We see the art of meditation work quite successfully in the process of childbirth. A significant amount of literature confirms a more relaxed state lowers the autonomic nervous system response and decreases the perception of pain. Learning how to meditate to alleviate stress could very help reduce or control the perception of physical pain. Acupuncture – Contrary to autonomic relaxation, acupuncture is an example of a counter-stimulus therapy used to manage pain. Originally indicated to restore balance by inserting minute needles into specific locations on the body, acupuncture has been found to be effective in treating neck pain, back pain, fibromyalgia pain, post-surgery pain, arthritis, and headaches, including migraines. A large review of the literature confirmed 70% efficacy of pain management with acupuncture compared to placebo (1), and provided analgesic relief in 55-85% of patients with chronic pain, compared to medications like morphine, which has 70% efficacy (2). Needles can be inserted along meridians, directly into trigger points, or by a technique known as dry needling. Exercise – Light to moderate exercise can help reduce pain. Yoga, for instance, is a great solution to help reduce pain associated with arthritis, muscle tension, as well as back and upper body pain. Tai chi is another form of exercise that can also be used to reduce pain and discomfort associated with various disorders, like fibromyalgia. It has also been shown to have tremendous effects on mood and the ability to handle stress. One must be mindful to not push through the pain when engaging in exercise for pain relief. Curcumin – A member of the ginger family and the major chemical component of turmeric, this spice has numerous clinical trials confirming its anti-inflammatory properties in the management of pain relief and reduction. Curcumin has been shown to downregulate and even inhibit the formation of pro-inflammatory genes and cytokines (3), and I’ve personally seen it effectively manage everything from arthritic pain to inflammatory bowel disease (Crohn’s/Colitis). Curcumin is best absorbed with fat and can be added to sauces and foods you eat, drank as a traditional tea known as “golden milk”, or can be taken in supplement form (always ask your ND for advice on choosing an effective curcumin product, as most won’t be absorbed). Increase Intake of Omega 3 – Omega 3 fatty acids, particularly eicosapentaenoic acid (EPA) can help reduce levels of chronic inflammation and pain perception. These fatty acids are precursors to protective prostaglandins and have been shown to change ratios of prostaglandins associated with chronic inflammation (4). They are found in the highest concentrations of fish and certain nuts and seeds, such as pumpkin seeds and flax. It has also been found to be an effective way to lower the pain and discomfort associated with various types of arthritis, slow tumour growth, and improve depression scores! Its generally advised to have a minimum of 1000 mg daily combined EPA+DHA for maintenance of general health, and closer to 3-4 g daily for pain modulation and cardiovascular health. Once again, talk to your ND about what fish oil is right for you, as fatty acids come from numerous sources, are subject to a number of different extraction methods, and spoil easily. As you can see, there are numerous effective natural ways to treat pain that do not require taking over-the-counter pain relievers. Remember, supplementation with some of the aforementioned therapies is not always safe for everyone, especially those on blood thinning medication. To discover if any of these therapies are right for you, or to discuss more ways to alleviate pain naturally, please feel contact Dr. Courtney Holmberg, ND at 647-351-7282 to schedule a consultation today! ​ Lewith GT, Machin D. On the evaluation of the clinical efficacy of acupuncture. Pain. 1983; 16: 111-127. Stux G, Pomeranz B. Basics of Acupuncture. New York: Springer-Verlag; 1988. Bharat B. Aggarwal targeting, inflammation-induced obesity and metabolic disease by curcumin and other nutraceuticals. Annu Rec Nutr. 2010; 30:14. 1-14.27 Galarraga B, Ho M, Youssef HM, Hill A, McMahon H, Hall C, Ogston S, Nuki G, Belch JJ. Cod liver oil (n-3 fatty acids) as an non-steroidal anti-inflammatory drug sparing agent in rheumatoid arthritis. Rheumatology (Oxford). 2008 May;47(5):665-9.