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

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

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

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

Our digestive tract is a complex system that relies on multiple factors to keep it regular. Its primary role is to break down the foods we eat, absorb the nutrients we require, and rid of the wastes we don't need. For some people, having a daily bowel movement is regular as clockwork, whereas others may go days on end before their next bowel movement. However, a daily bowel movement is not the only sign you should pay attention to when evaluating your gut motility. The consistency of the movement is also important, with denser movements often indicating your gut motility is lagging, while loose movements mean motility is rushed. Having a daily bowel movement is often considered to be a staple indication of overall health, as well as a telltale sign of the state of your gut environment. And while everyone's norm may look different, consistency is critical nonetheless. The most common factors that affect regularity are often diet, exercise, and fluid intake. However, bowel function is fundamentally a nervous system response, meaning it can be manipulated beyond simple lifestyle factors. In order to help you hack gut motility, let’s first break down the actual mechanism of how a bowel movement happens, and the neurotransmitters and nutrients that maintain its function. What Stimulates Bowel Movements? The gut maintains is own unique enteric nervous system, which acts independently of your autonomic system to create muscular contractions known as peristalsis. Peristalsis propels food through the digestive tract and eventually out of the body. In order for this system to function correctly, it requires regular signalling of its muscles to release and contract, which are regulated by the neurotransmitter, acetylcholine. An abundance of acetylcholine binds to cholinergic receptors to encourage contraction, and the ultimate breakdown of acetylcholine encourages relaxation, creating the rhythmic waves of peristalsis we desire. How Can You Increase Gut Motility? The moral of this potentially overly science-y story is proper acetylcholine management = proper gut motility. This neurotransmitter is a combination of two primary molecules: acetyl CoA and choline, formulated via the enzyme choline acetyltransferase (ChAT). ​ First, we need to create acetyl CoA, which is relativity easy to do since in the nerve cell, its primarily accomplished by converting glucose into acetyl CoA during glycolysis (figure 1). Glucose is ingested naturally via carbohydrates, so step one is to ensure you're ingesting a sufficient amount of complex carbohydrates each day (this is one of the reasons why some people who follow a low-carb or SCD, FODMAP, or ketogenic diet may notice more constipation). Step two is to ensure these carbs break down into their desired metabolites, which requires the right amount of thiamine, or vitamin B1. This vitamin upregulates a critical enzyme known as pyruvate dehydrogenase and supports the conversion of glucose into acetyl CoA instead of lactate. ​ Funny enough, the most commonly fortified thiamine foods tend to be processed carbohydrates, which are often the first things we cut out of our diets when we want to make healthier eating choices. The very cause of irregular bowel movements could easily be a lack of thiamine in your diet, which can be remedied by increasing the intake of vitamin B1. Most adults should consume at least 1.2 mg of thiamine daily, and children between the ages of 1 and 18 should get between 0.5 and 1 mg (1). Secondly, we need the micronutrient choline, which is found in the highest amounts of fatty foods such as eggs and salmon, or vegetables like cauliflower and Brussel sprouts. It can also be supplemented in forms such as citicoline, but it's best to speak to your healthcare provider before doing so. Once you are consuming healthy carbs, choline, and vitamin B1, you also need to make sure your body is producing choline acetyltransferase (ChAT) enzymes to turn acetyl CoA and choline into our desired neurotransmitter, acetylcholine. Thankfully, ChAT production occurs naturally within the body. Butyrate is a short-chain fatty acid made by healthy gut flora via the fermentation of fibre. It has been shown to help increase ChAT production (2), as well as support healthy gut barrier function and prevent increased intestinal permeability (more commonly nicknamed “leaky gut syndrome”). Eating more fibrous veg, or consuming butyrate-rich foods, such as butter, may support gut motility. Another option could be fibre supplementation with partially hydrolyzed guar gum (PHGG), which is my fibre of choice. PHGG has been shown to decrease symptoms of irritable bowel syndrome (3,4), and benefit the growth of Bifidobacterium and butyrate-producing bacteria in the human large intestine (5), without causing the majority of side effects seen with psyllium use. Why Coffee and Nicotine Make You Poop! Most people report bowel movement stimulation after a cup of coffee, and 1 in 6 people experience constipation when they quit smoking. You’ve probably guessed by now that it's because these two stimulants have direct impacts on acetylcholine. Coffee (particularly, caffeine) actually functions as an acetylcholinesterase inhibitor, meaning it slows the breakdown of acetylcholine in the postsynaptic cleft, allowing it to provide more nerve stimulation and muscle contraction. Nicotine binds directly to the cholinergic receptors that acetylcholine activates, producing similar effects as this neurotransmitter. The take-home message... If you’re trying to quit coffee or smoking, but are fearful of the effects on your gut, know there are alternative ways to get things going without all the dangerous side effects. There are many factors causing irregular bowel movements, with a lack of acetylcholine being just one of them. If you want further help to determine the cause of irregular bowel movements 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!