Histamine intolerance symptoms are experienced by many people, although it still remains relatively misunderstood (that being said - research on the topic is quickly expanding). Its severity ranges from more severe IgE-mediated symptoms to milder intolerances to fermented or aged foods containing high histamine levels. Here, we’ll examine more about this condition, its causes, and what you can do to alleviate symptoms. ​Allergies form when the immune system improperly identifies an otherwise harmless molecule like a dust particle or pollen as a danger, mounting an immune response and producing the symptoms we’ve come to recognize as ‘allergies”. What Is Histamine Intolerance? Histamine intolerance is when the body has trouble with histamine clearance, either from excessive production or difficulty breaking it down. Since major of mast cells line our skin and mucous membranes, most symptoms include congestion, itching, and gastrointestinal disturbances. Since the disorder is driven by excessive histamine in the body, the cause could be as simple as consuming too many histamine-rich foods like alcohol, fermented foods, and dried/aged food, or in more complicated cases it could due to trauma to the intestinal lining and/or downregulation in the enzymes diamine oxidase (DAO) and histamine N-methyltransferase (HNMT) in the gut that assistance in histamine clearance. ​ How is a Histamine Intolerance Diagnosed The simple answer is - clinically. While appropriate testing for histamine intolerances can be helpful to not only isolate the cause of the issue but support recovery long term, negative tests cannot always rule out an intolerance. This is where an experienced diagnostician can come in handy. It's also important to note that histamine intolerance is not an allergic reaction or food allergy, so traditional skin-scratch and allergy tests will be negative. What makes histamine intolerance so insidious is that it can manifest in many different ways. Common symptoms of histamine intolerance include: Wheezing/shortness of breath Hives or dermatographia Eczema Fatigue Bloating Diarrhea Heartburn/Reflux Irregular/painful menstrual cycle Headaches Nasal congestion/itchy eyes and nose Increased anxiety An elimination diet and challenge remain one of the best ways to know if you have histamine intolerance. Physicians may also check the levels of histamine in your bloodstream or take a skin biopsy, but this type of testing is more effective for conditions like mast cell activation syndrome. The DAO enzyme can also be measured, however as mentioned previously, normal results do not rule out an intolerance. Lastly, secondary histamine intolerances are more common in individuals with Irritable bowel syndrome, inflammatory bowel syndrome, dysbiosis or an overgrowth of bacteria in the gut. This is where SIBO testing and stool testing should be considered. Treatment with a Low Histamine Diet Regimens ​​ Since histamine intolerances are a by-product of how your body processes dietary and internal histamine, eliminating dietary intake can keep your levels below symptomatic thresholds. However, while eliminating high-histamine foods from your diet may seem like a simple solution, it can also be an overwhelming and restrictive process. As foods age, they increase in histamine content. This makes foods like smoked and aged meats, cheeses, vinegar, wine and fermented foods naturally high in histamine. Also, longer shelf life foods, previously frozen, and ever leftovers will also typically have higher histamine contents. Also, as you can see, the list can grow quite large, and whether or not we can achieve an absolute histamine-free diet becomes debatable. This is where I often recommend exploring why a histamine intolerance occurred in the first place. Since we know histamine intolerances are more common in people with gastrointestinal issues, this is often where I start. Furthermore, probiotics, antioxidants and vitamin C have all been shown to have favourable impacts on mast cell stabilization, which can expedite recovery over the long term. To learn more about histamine intolerances, proper diagnostic assessments, and treatment options, please contact Toronto Naturopathic Doctor, Dr. Courtney Holmberg at 647-351-7282 to schedule your appointment today.

Irritable bowel syndrome (IBS) is the most common gastrointestinal disorder worldwide, affecting more than 5 million Canadians each year (that's 1 in every 6 people). It includes symptoms such as indigestion, bloating, excessive gas, constipation, and/or diarrhea. However, a proper diet is one of the ways IBS can be managed. A common strategy has always been to incorporate ‘healthy’ food and avoid the ones that worsen the symptoms, however, some are surprised to find out that a diet rich in fruits and vegetables can sometimes actually make symptoms worse. This is where we look at something called the low FODMAP diet, which has been clinically proven to help ¾ of IBS sufferers. Let’s learn more. In this diet plan, the food items are classified as low, moderate, and high food. People with IBS must avoid high foods and consume low foods to determine a decrease in symptoms. However, if a person consumes low food excessively for long periods of time, it can also be harmful to gut microflora and increase your risk of nutrient deficiencies, so it's always important to talk to your doctor, naturopath or dietician about how long to avoid these foods, when to determine benefit and how to reintroduce. How Does A Low FODMAP Diet Work? A low FODMAPs diet aims to help you learn which foods (if any) you do not tolerate and which are the trigger for your IBS. The diet consists of a 3 step process, as follows: 1 - Elimination This phase can range from 3 to 8 weeks, depending on the person’s health and condition. In this, the individual is required to eliminate all high FODMAP food from their diet. Remember, the FODMAP list is extensive and can restrict some key nutrients for some individuals, so it’s always best to work with a professional through this phase. 2 – Reintroduction If after elimination, the symptoms significantly reduce or resolve, it’s safe to conclude that one or more high FODMAP foods are a trigger for IBS symptoms. You then must start incorporating FODMAP foods into your diet in a systematic way to determine the source of the intolerance. Generally, a person must eat the FODMAP foods at least once every day to every other day for ~3 servings to identify the trigger foods, increasing the quantity of the food each time. Monitoring symptoms through exposure will help determine which sugar groups are safe and which ones are not. 3 – Maintenance Now that the trigger food is traced, a person can return to their original diet while limiting the food that produces the IBS symptoms. At this point, most people are able to return to their original diet (minus a few possible avoidances) without symptoms. Key Foods To Avoid Vegetables: mushrooms, asparagus, cauliflower, beetroot, onions, and garlic Fruits: cherries, mangoes, watermelon, peaches, pears, apples, and apricots. Dairy: lactose-containing cow milk, cottage cheese, yogurt, ricotta cheese, ice cream, and custard Grains And Cereals: rye, wheat, kidney beans, soy products, lentils, and chickpeas. Sweeteners: Honeys, agave nectar, high fructose corn syrup, cough medicine, sorbitol, and sugar-free gums. Many lists suggest slightly modified food restrictions, and the list you see above is very simplified. The most valuable resource I generally recommend for patients embarking on a FODMAP diet is the smartphone app made from Monash University called ‘Monash University FODMAP diet’. The guidelines of Monash University tend to be the most detailed and well-researched. The Bottom Line The low FODMAP diet plan is proven and has helped many people with Irritable bowel syndrome. However, make sure to contact a professional dietitian or Naturopath Doctor who is versed on the FODMAP restrictions before following any diet plan. Many people stick with the low FODMAP diet for a long time because it eliminates IBS and improves overall well-being, however, you must way out the benefits against the risk in every case. Resources: https://www.monashfodmap.com/ibs-central/i-have-ibs/starting-the-low-fodmap-diet/ https://www.monashfodmap.com/ibs-central/i-have-ibs/get-the-app/

Migraines can be excruciating. ​They can be so severe that women with migraines may miss work or even school due to the severity of their condition. If you're one of those people, you need to understand the cause of your migraines so that you can take steps to prevent them from happening. While you may experience many different types of migraine, hormonal migraines rank among the most common type and affect up to 30% of women in Canada who suffer from this hormonal condition. What Are Hormonal Migraines? Hormonal migraines are a type of migraine that occurs in women around the time of their menstrual cycle. They commonly include severe headaches and can also cause nausea and vomiting, as well as sensitivity to light, sound, or smell. Hormonal migraines differ from other types of migraines. For example, they don't have the same warning signs that different types of migraines do. In addition, they don't cause auras before the headache starts, and they aren’t as often triggered by things like alcohol or stress (although they can certainly make it worse). They also don't respond to the same treatments as non-hormonal migraines do: Painkillers won't help, and neither will triptans (drugs used for treating other kinds of migraines). What Is the Link Between Hormones and Migraine Headaches in Women? Changes in hormone levels in your body trigger hormonal migraines. While the true cause of hormonal migraines is not entirely understood, they typically occur when a drop in estrogen, progesterone, and other hormones occurs before a menstrual bleed. It’s believed that estrogen and serotonin have a direct correlation, so when estrogen drops, serotonin drops, which may be the source of the migraine’s onset. Hormonal migraines affect women more often than men. They also occur more frequently during pregnancy and after childbirth. The most common symptom of a hormonal migraine includes a headache that usually starts on one side of the head and spreads across the whole head. It can also accompany nausea, vomiting, and sensitivity to light and sound. The most frequent hormone-triggered migraines occur two weeks before menses begins and during the first few days of menstruation. A woman's risk of having a hormonal migraine increases as she approaches menopause, and hormonal migraines often resolve when she reached menopause. Something to make note - oral birth control pills can worsen (or may be the cause of) hormonal migraines. If you are experiencing severe premenstrual headaches and are using an oral hormonal contraceptive, talk to your doctor about a change to your contraceptive. If you suffer from hormonal migraines and want to resolve your symptoms, contact Toronto-based Naturopathic Doctor, Dr. Courtney Holmberg. With over ten years of experience in helping patients with hormonal imbalances and other conditions, Dr. Holmberg ND understands the importance of taking a holistic approach to migraine management, looking at the whole person—not just the symptoms—to find solutions that fit each individual's needs. Call 647-351-7282 today to book your appointment with her clinic to get to the bottom of your hormonal migraines today.

Bloating. It's a concern patients report almost daily in clinical practice, and a symptom we're all familiar with. Whether it shows up after an overindulgent meal, with our monthly menstrual cycles, or has become a daily struggle, the discomfort is real and the cause is difficult to pinpoint. Most of us can relate to the symptom, but it's important to recognize that bloating is just that... a symptom. And while I'll give you some great tips to manage the bloating, the trick to banish it for good is to determine where it's really coming from. What causes it? While excluding the more emergent or complicated causes of bloating, the uncomfortable abdominal distention is most commonly attributed to two overarching concerns: digestive dysfunction and/or hormonal dysregulation. Digestive Dysfunction: if your bloating happens following meals, or if you wake with a flat stomach in the morning, but carry a 3-month food baby by bedtime, it could be related to your digestion. low stomach acid: an acidic state is required to digest foods and absorb micronutrients. When the stomach lacks acidity, these foods do not get broken down and absorbed, but rather fermented by bacteria in the gut, leading to symptoms of gassiness, bloating, and sometimes even stool changes. food intolerances: much like any other inflammatory reaction, food intolerances create an inflammatory state in the gut, leading to fluid retention and ultimately, bloating. Learn more about food allergies here >> dysbiosis: an overgrowth of bacteria and yeast in the stomach can also be a cause of foods being fermented instead of digested. There may also be an association with bacterial overgrowth in otherwise sterile environments, such as the small intestine, referred to as small intestinal bacterial overgrowth (SIBO). It is suggested that roughly 75% of IBS cases are actually misdiagnosed SIBO. Talk to me about SIBO here >> Hormonal Dysregulation: if your bloating is present even upon waking, has no correlation to food, or has a cyclical pattern with menstrual flow, it could be your hormones. excess estrogen: breast tenderness, water retention, and swelling/bloating before menses with heavy bleeding are often attributed to too much estrogen in the body low progesterone: another cause of bloating before menses, that typically lasts anywhere from ~2 weeks before flow, with short cycles and long bleeding times (>6 days). Since progesterone produces a lovely calming effect on the body (the pregnancy glow), low levels cause be a source of premenstrual irritability. Learn how to investigate your personal hormone profile here What can I do about it? 1. Castor oil packs - saturate an old face cloth with castor oil and apply directly to the lower abdomen with a heating pack for ~30 mins for temporary relief of bloating. Be careful not to do this during menses, as castor oil has a very stimulating effect, and will make flow heavier. 2. Lemon water - lemons are a natural diuretic and gentle laxative, and hydration is essential to stop bloating (since dehydration causes your body to hold onto water). Have some lemon water first thing in the morning on an empty stomach to spark digestion, and detoxification, and reduce salt retention in the body. 3. Watch WHAT you eat - dairy, wheat, carbonated beverages, beans, and sugars/sweeteners have all been associated with increased bloating. Dairy and wheat can be pro-inflammatory to the gut, carbonated beverages increase gas buildup, beans contain undigestable sugar which gut bacteria love to ferment, and sugar feeds those unwanted gut bacteria. Things like bitters before meals and peppermint tea following meals work well for bloating surrounding eating. 3. Watch HOW you eat - chew your food thoroughly and don't eat on the run, Ditch the chewing gum, and skip the drinking straws. All these habits cause you to swallow air into the digestive tract and is a common source of temporary bloating. 5. A good probiotic - rebalancing the gut bacteria can be essential to eliminating bloating for good. High amounts of the probiotic strains L. acidophilus & L. caseii have been shown to help relieve bloating symptoms. However, the wrong probiotics can actually make symptoms worse, and should be introduced following antimicrobial treatment for those suffering from SIBO. Talk to your Naturopath to see if probiotics are right for you.

One of the most important focuses in life is prioritizing our mental health. Whether you prefer self-care practices, meditation, yoga, or even beauty routines, engaging in something that slows us down and focuses us inwards is beneficial. But believe it or not, outside of exercise and meditation, one of the best ways to support your mental health is to adopt habits that support your gut health. But what is the connection between gut bacteria and mental health? Our gut is the home of our enteric nervous system, often referred to as our "second brain,” and evidence shows the microbiota in our gut can produce neurotransmitters that can largely influence this nervous system. Beneficial bacteria in our gut have the capability of influencing our mood, encouraging vitamin production, regulating a healthy sleep rhythm, and benefiting hormone production. The synergy between the Gut-Brain via our microbiome has significant implications for supporting mental health and overall well-being. Our Microbiome's Impact on Our Mental Health To understand the microbiome's impact on our mood, we must first understand the gut-brain axis. The gut-brain axis (GBA) consists of bidirectional communication between the central (aka ‘fight or flight’) nervous system and the enteric (a large division of the ‘rest and digest’) nervous system, linking emotional and cognitive centers of the brain with peripheral intestinal functions like blood flow, transportation and immune function. The gut-brain axis's primary mechanism is to regulate: - production, expression and turnover of neurotransmitters (serotonin, GABA etc.) - protection of the intestinal barrier - modulation of enteric sensory afferents (digestion, absorption, elimination) - making short-chain fats that influence memory, mood, learning, and inflammation - immune regulation Communication between these two systems involves the release and binding of neurotransmitters, most notable being GABA, dopamine and serotonin (1). Not only do they influence the way we feel, but they also influence the peripheral intestinal functions we just mentioned. Another interesting fact - during fetal development, the gut and brain tissue comes from the same cells in the embryo, which split to create two separate organs connected by the vagus nerve. In 2012, the Human Microbiome Project Consortium was published, creating a framework for the structure, function, and diversity of the healthy human microbiome. From there, research progressed to show that our gut microbiomes can have an impactful influence on our mood, and vice versa. Numerous studies associate gut health and Parkinson's disease, anxiety, and depression. For example, people with low diversity in the gut are more likely to experience anxiety and depression. Data suggests as our diet influences our microbiome, our microbiome influences the activity of our vagus nerve, which is directly correlated to our capacity to regulate stress responses (2). This is the same mechanism that breathing, yoga, and meditation contribute to stress resilience and mitigating mood and anxiety symptoms. How to Support Your Microbiome for Mental Health Essentially, consuming the right foods and probiotics can improve mental health and well-being. Let's break down some of the most impactful changes you can make. Remove inflammatory foods Eliminating pro-inflammatory foods like sugar, gluten-containing grains, and dairy might be a great place to start if you’re experiencing mental health struggles. These foods have been linked to increased levels of systemic inflammation and the resultant decline in our beneficial flora (3). Instead, incorporate more fresh fruits and vegetables, fibres, and anti-inflammatory spices that can affect your microbiome food sources and support. For example, some of the best gut-boosting spices that promote inflammation reduction are saffron, turmeric, bay leaves, ginger and cinnamon. Incorporate fermented foods and probiotics. Research suggests that specific probiotic strains have the capability of influencing our mood, gut function, and inflammation levels. Of particular interest are the strains Lactobacillus helveticus R0052 and Lactobacillus rhamnosus R0011, with studies demonstrating better stress levels and coping skills, which may be a result of benefits on barrier function and suppressing inflammation (4). Eating more fermented foods like yogurt, kimchi, sauerkraut and kombucha (watch for added sugar) can significantly increase your exposure to probiotics. Eat More Fibre Eating nuts, seeds, and leafy greens is vital as they are rich in fibre, folate, iron, and other vitamins. Leafy greens like Swiss chard, spinach, arugula, and collard greens are excellent sources of folate. Folate is an essential vitamin, helping to decrease depressive symptoms, and nuts, seeds and greens rich in soluble fibre improve gut bacteria by acting as a source of nutrition. Good bacteria eat these fibres to produce short-chain fatty acids (most notable being butyrate), which have been shown to regulate nutrient absorption, reduce inflammation and oxidative stress on the gut lining, reinforce gut barriers, and improve motility. Furthermore, an increasing number of studies have stressed the role of butyrate in the prevention and inhibition of colorectal cancer. Beyond the gut, butyrate is also showing promising potential for its therapeutic benefits in hemoglobinopathies, genetic metabolic diseases, and metabolic diseases (insulin resistance, high cholesterol, and ischemic stroke). Support Your Vagus Nerve The vagus nerve is comprised of a group of afferent fibres that originate in numerous layers of the intestinal walls, and connect to an area in the brain that regulates hunger, appetite, and the digestive process via gut hormones and regulatory peptides like ghrelin, cholecystokinin (CCK), glucagon-like peptide-1 (GLP-1), and peptide YY (PYY). What's even more interesting is there seems to be a symbiotic relationship between your microbiome and these gut hormones, which ultimately bind to chemoreceptors and regulation our food intake and energy balance. Strengthening your Vagus nerve may include things like cold plunges, breathwork, humming/singing, morning sunlight, and certain forms of meditation. A really practical way to actively support your Vagus nerve would be to check out the Nerva App (a personal fav) Focus on Vitamin D While not entirely correlated to gut function, it's always essential to highly that not receiving enough vitamin D can lead to significant increases in anxiety and depression. Unfortunately, vitamin D deficiency is common, so it is essential to implement more foods rich in this vitamin. Herring, salmon, cod liver oil, sardines, and egg yolks are some of the best vitamin D-rich foods, but it’s important to supplement during winter months to ensure you're getting enough. Naturopathic Support for Your Gut-Brain Axis If you want to take a different approach regarding your mental health, start by considering how your gut influences your feelings. Naturopathic support aims to remove the aggravators, improve the gut barrier, and restore the microbiome to get you back to feeling like the person you were meant to be. Dr. Courtney Holmberg, a Naturopathic doctor in Toronto, has a clinical focus on digestive health, the microbiome, and its influence on mental health. Contact us at 647-351-7282 to book an appointment. References: https://pubmed.ncbi.nlm.nih.gov/25830558/ https://pubmed.ncbi.nlm.nih.gov/29593576/ https://pubmed.ncbi.nlm.nih.gov/25415497/ https://www.wageningenacademic.com/doi/abs/10.3920/BM2011.0032 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070119/

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/

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

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.

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

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.

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