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    The thyroid is responsible for producing various hormones in the body that help regulate metabolism and provide support for other bodily systems, like the immune system and cardiovascular system. Thyroid hormones help improve the absorption of nutrients from the foods we eat. They assist with gut motility. They regulate our appetites. Additionally, these hormones help boost our basal metabolic rate to burn calories. Other functions of thyroid hormones include helping metabolize glucose and break down fats. Cruciferous vegetables consist of a wide range of vegetables that contain glucosinolates or goitrogens – a sulphur compound found in kale, broccoli, arugula, turnips, cabbage, cauliflower, and other vegetables. People with thyroid problems, such as low functioning or autoimmune disorders are typically advised to avoid cruciferous vegetables due to their ‘goitrogenic’ effect. It was previously believed that consuming cruciferous vegetables could inhibit thyroid hormone production in people with thyroid problems. Yet, the consumption of these vegetables does have health benefits, like reducing the risks of certain cancers. Various research studies have been conducted on animals where the subjects were fed cruciferous vegetables and the impacts on thyroid functions are studied. In one study, two test groups were given a diet of 7% freeze-dried rutabaga sprouts – one group with iodine deficiencies, and the other group on a sulfa-based antibiotic. Surprisingly, the spouts had a protective effect on the thyroid in test subjects that were iodine deficient. However, in test subjects that were antibiotic-treated, the initial study showed the sprouts enhanced hypothyroidism. (1) However, a second study later demonstrated the sprouts did not enhance hypothyroidism in sulfadimethoxine-treated subjects. (2) It was also noted that the consumption of the sprouts helped reduce oxidative stress on the thyroid. In both sets of test subjects, the cruciferous sprouts showed a reduction in proinflammatory cytokines. Another study in 2018 examined a 7% free-dried broccoli diet. The introduction of broccoli into the diet did not result in any changes to thyroid function. In iodine-deficient subjects, broccoli helped boost the antioxidant capacity of the thyroid. In sulfadimethoxine-treated subjects, the broccoli also helped to protect the thyroid. (3) In 2019, a study of the effects of cruciferous vegetables on thyroids in humans was conducted. Test subjects were given treated freeze-dried broccoli extract, untreated broccoli extract, or no broccoli extract for 84 days. At the conclusion of the study, subjects that received either type of broccoli extract were compared to those that receive the placebo. Finding found that certain test subjects exhibited a decrease in certain thyroid problems as the broccoli extract provided support to the thyroid. The study reported there were no noticeable changes in thyroid functioning compared to baseline findings. (4) So, are cruciferous vegetables safe for my thyroid? In conclusion, a summary of the limited research in both human and animal studies suggested that consuming cruciferous vegetables even by people with thyroid problems could potentially provide certain health benefits, such as antioxidant and anti-inflammatory effects on the gland, without a negative impact on its functioning. So the next time you read you should be avoiding broccoli if you have a thyroid condition – think again! If you have thyroid problems, have questions or concerns about thyroid disorders, and are looking for naturopathic treatment in Toronto, please feel free to contact Toronto Naturopathic Doctor, Dr. Courtney Homberg at 647-351-7282 to schedule your appointment today. Sources:


    Autoimmunity is an umbrella term for a number of medical conditions with one common problem: the immune system. In autoimmunity, the body’s immune system mistakenly identifies healthy cells as invaders and attacks them. This disease can present in various forms and can affect any part of the body. For some, autoimmunity can disrupt hormone production, as in Hashimoto’s or Graves. In other people, it can present as a symptom of inflammation, fatigue, and pain. Some people even experience neurological changes, as in cases of MS. And while autoimmunity is not news to modern medicine, the increased number of reported cases per year is. It poses the questions - why are incidence reports on the rise, what, if anything, is causing its increase, and is there anything we can do about it? According to recent research, the increase in the number of new autoimmunity diagnoses has been growing between 4% and 9% annually, with the highest reported onset of the new disease being rheumatoid arthritis(1). Part of this increase may be contributed to increasing awareness and accurate diagnosis of autoimmunity, particularly celiac disease. Another concern is the increase in the likelihood of secondary autoimmunity in patients with previous diagnoses. Basically, once you have been diagnosed with one type of autoimmunity, the risk of developing another autoimmune disorder also increases. What Causes Autoimmunity? Our immune system responds to foreign invaders by attack and destroys tactics to keep the body healthy and strong. Sometimes, the body mistakes certain ‘self’ cells as an invader and triggers an immune response. Part of this response involves the production of both inflammatory and anti-inflammatory cytokines, intended to create edema, white blood cell influx and tissue reconstruction, but also regulate the process as it occurs. There needs to be a careful balance between the two types of cytokines to avoid negative outcomes, and without it, inflammation gets out of control and we lose grasp of immunologic tolerance to our own cells, leading to autoimmunity. While there is no single underlying cause for autoimmunity, multiple factors have been attributed to the disease's development. Some of these factors include, but are limited to: Stress Genetics Infectious Diseases Gut Dysbiosis Toxin & mould exposure Research studies have shown that about 30% of all cases are from genetic factors(2). The remaining 70% of cases are caused by other factors. This is good news because it means that the remaining 70% of factors may be modifiable if we can identify them and change them before autoimmunity onset. Early detection and modification may even lead to the prevention of autoimmune development together. Modifiable risk factors associated with increased risk of autoimmunity Some of the modifiable risk factors triggering autoimmunity may include certain foods we eat or toxins we come into contact with. Examples include: Increased organic solvent exposure, is commonly found in dry cleaning, paint thinner, nail polish remover, perfumes and detergents (3). Changes in intestinal tight junction permeability (aka ‘leaky gut’) associated with industrial food additives (4). Sugar, salt, emulsifiers, and gluten (4). Tobacco and alcohol use, as well as some medications including cardiovascular drugs, antiepileptic drugs and slow-acting anti-inflammatory drugs (5) Drinking cow’s milk may increase autoimmunity due to the cross-reactivity of albumin (6) Gut dysbiosis (aka imbalances in our microbiome) (7). It is important to remember autoimmunity develops from multiple factors. A good number of these factors can be controlled with changes to your diet and environmental habits. ​ For further information about autoimmune disease and reducing risks, please feel free to schedule an appointment with Toronto Naturopathic Doctor, Dr. Courtney Holmberg ND by calling 647-351-7282 or booking online today! LernerC, JermaisP, MatthiasT. TheWorldIncidenceandPrevalenceofAutoimmuneDiseasesisIncreasing. InternationalJournalofCeliacDisease (2015); 151-155. Barragán-MartínezC, Speck-HernándezCA, Montoya-OrtizG, MantillaRD, AnayaJM, Rojas-VillarragaA. Organicsolventsasriskfactorforautoimmunediseases: asystematicreviewandmeta-analysis. PLoSOne. 2012; 7(12): e51506. Fasano, Alessio. “Zonulin, RegulationofTightJunctions, andAutoimmuneDiseases.” AnnalsoftheNewYorkAcademyofSciences 1258.1 (2012): 25–33. ThierryVial, BrigitteNicolas, JacquesDescotes. Drug-inducedautoimmunity: experienceoftheFrenchPharmacovigilancesystem. Toxicology.1997; 119(1): 23-27. MacFarlaneAJ, etal. AType 1 Diabetes-relatedProteinfromWheat (Triticumaestivum) cDNACloneofaWheatStorageGlobulin, Glb1, LinkedtoIsletDamage. JBioChem. 2003;278:54-63. OpazoMC, Ortega-RochaEM, Coronado-ArrázolaI, BonifazLC, BoudinH, NeunlistM, BuenoSM, KalergisAM, RiedelCA. IntestinalMicrobiotaInfluencesNon-intestinalRelatedAutoimmuneDiseases. FrontMicrobiol. 2018 Mar12;9:432.


    Millions of people around the world live with autoimmune disorders, which is why it’s so important that our understanding of these disorders continues to grow rapidly. A growing body of research suggests that chronic illness responds best to a multifaceted methodology of diet and lifestyle changes that include a focus on anti-inflammatory nutrition, moderate exercise, adequate and plentiful sleep, and reasonably reducing stress. This approach to managing autoimmune disease has been termed ‘the Autoimmune Protocol’ (AIP) and may be the key to successfully managing autoimmune disorder symptoms. What you eat matters. What we put into our bodies has a significant impact on our health – even for those of us considered generally healthy. Processed foods, refined sugars, and saturated fats can contribute to the onset of autoimmune symptoms. But even some ‘good-for-you’ foods may affect gut flora and result in the recurrence of autoimmune symptoms. To allow the body to heal from the effects of autoimmune symptoms, it is important to stick to nutritionally dense foods, but more importantly, avoid ingredients that promote inflammation and hence immune activation. Such items include: Processed vegetable oils: corn, canola (rapeseed), palm kernel, peanut, safflower, sunflower and soybean oil Processed food chemicals: artificial colours and flavours, emulsifiers (carrageenan, cellulose gum, guar gum, xanthan gum, lecithin), monosodium glutamate (aka MSG), nitrates/nitrites (naturally occurring are ok), phosphoric acid, propylene glycol, textured vegetable protein (aka TVP), trans fats (hydrogenated and partially hydrogenated vegetable oils, such as margarine), yeast extract, and any chemical on a label you don't recognize or can’t pronounce. Problematic sugars and sweeteners: agave/agave nectar, barley malt, brown rice syrup, cane sugar, caramel, corn sweetener, high fructose corn syrup (really, any corn syrup), crystalline fructose, dextrin, dextrose, evaporated cane juice, fruit juice concentrate, galactose, glucose, inulin, lactose, monk fruit, maltose, maltodextrin, rice syrups, sorghum syrups, sucrose/sucralose, and of course, refined sugar Instead, replace for: Olive oil (at room temperature) or avocado oil when cooking (due to high smoke point and low trans/saturated fats Vegetables such as beets, asparagus, sweet potatoes, and kale Fruits as a sweet treat, such as apples, figs, grapes, and melons Sweeteners such as stevia or erythritol (if you have no gastrointestinal issues) When you eat matters. Just as important as what we put into our bodies when we put nutrition into our bodies also matters. According to recent studies [1], disruptions to our eating and fasting cycles can contribute to an imbalance in gut microbiota and an increase in inflammatory responses. Try to avoid forcing eating when feeling stressed. Avoid eating late at night, before bed, or during the night. Stick to regular mealtimes instead of grazing throughout the day. Exercise to improve your gut biome. Many autoimmune disorders are stress-triggered. Regular aerobic exercise has been recommended for decades as a natural and healthy way to reduce stress and cortisol levels while increasing feel-good endorphins. Exercise can help to manage the symptoms of chronic illness. But beyond merely symptom management or de-stressing, exercise can improve your gut biome (which we know to be a key factor in the development of autoimmunity). In a recent study [2], scientists studied participants just beginning an exercise regimen. For several weeks during active exercise, the researchers discovered the increased presence of microbes that produce short-chain fatty acids – the acids that help repair damage from inflammation, fight insulin resistance, and help boost metabolism. The presence of these microbes was significantly diminished after participants stopped exercising regularly. Manage your lifestyle. Our constantly-connected sleep-deprived lifestyles are doing more harm than good – especially to our microbiota – and may be contributing factors, along with diet, to the development of autoimmune disorder symptoms. To mitigate these symptoms, it is important to get plenty of sleep and eliminate as much unnecessary stress from daily life. Mindfulness meditation – meditation has been shown to reduce stress, give us a deeper sense of well-being, and help regulate circadian rhythms. It’s also been shown to change our microbiome. Digital detox – being constantly connected not only exposes us to excessive amounts of light but keeps our stress levels up. At least an hour before bedtime, turn off all electronic devices and turn down the lights. Get outside – fresh air and natural light can help restore natural circadian cycles and help reduce stress. Connecting barefoot with the grass, also known as grounding, “reduces pain and alters the numbers of circulating neutrophils and lymphocytes, and also affects various circulating chemical factors related to inflammation” [3]. For more help with supporting your gut health, achieving a balanced lifestyle/diet, or general health guidance in autoimmunity, please feel free to schedule an appointment online with Dr. Courtney Homberg, Naturopathic Doctor in Toronto, or by calling the clinic at 647-351-7282 today! ​ References: [1] [2] [3]

  • PCOS and Pregnancy

    PCOS is a medical condition that affects hormone levels in women, impacting 5%–20% of women of reproductive age worldwide and characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. Women with PCO end up producing a higher amount of male hormones, like testosterone and often experience resistance to the metabolic hormone, insulin. These imbalances can lead to issues with acne and missed menstrual periods (impacting fertility), amongst other symptoms. The 2003 Rotterdam criteria are currently the internationally accepted criteria by which PCOS is diagnosed. However, the pathogenesis of polycystic ovary syndrome (PCOS) is poorly understood. Part of the research conducted on the origination of the disease has shown that the likelihood of PCOS development in women may be determined at birth. Research in primates suggests that excess fetal androgen exposure may predispose the infant to the later development of PCOS through alternations in the epigenome (1). If there is an imbalance of hormones from PCOS during pregnancy, then there is an increased likelihood the baby may also develop PCOS if the infant is born female. Additionally, exposure to testosterone prior to pregnancy could lead to PCOS even when women have children later. Gestational diabetes and insulin resistance could also be potential risk factors for PCOS pregnancies. Not only are mothers with PCOS more likely to develop gestational diabetes (2) (some resources suggest getting tested even earlier than 24-28 wks because of this), pregnancy-induced hypertension, pre-eclampsia, preterm labour, and cesarean sections rates are higher in mothers with polycystic ovaries (3). From an environmental standpoint, we also must consider external influences on fetal epigenetics. PCE (perchloroethylene, commonly found in adhesives, household cleaners and dry-cleaned clothing) and bisphenol A (plastics) are two chemicals that when exposed to can lead to PCOS not just for a single infant, but for future generations (4). Can PCOS Come from Fathers? Research studies on whether PCOS could be passed from fathers to their babies have been conducted, and have found that there may be a connection through genetics, but not in the in-utero environment. The studies have found that male pattern baldness, metabolic issues, and obesity in fathers can influence if their offspring develop PCOS (5). The studies also found that even though male infants do not develop PCOS, they could essentially be affected by exposure to excess androgen while in the in-utero environment. Essentially, a male baby could be a future contributor to PCOS when they have children. Testing AMH as a predictor for PCOS AMH (Anti-Mullerian-Hormone) is a hormone found in women that seems to be a reliable predictor of certain hormonal problems, like PCOS. PCOS research has found that AMH levels in affected women tended to be higher throughout their pregnancy. However, for women with a higher BMI (body mass index), AMH was not always a good indicator of PCOS. Your naturopath may chose to order your AMH when assessing fertility status, in cases of multiple miscarriages, or if classic markers for PCOS diagnosis seem unclear. It may also be used as a helpful indicator of egg quality in patients without PCOS. Reducing Risks of PCOS While women cannot control the genetic factors contributing to their in-utero environment, there are some simple strategies they can try to reduce risks of higher androgens/insulin during pregnancy and the resultant impacts on their children. Exercise and Eat a Healthy Diet: It is important to be active and eat a healthy diet. Doing so will help control blood sugar levels, prevent insulin resistance, and reduce the risks of developing gestational diabetes during pregnancy. It’s also important to not over-exercise, as excessive exercise may increase over-androgen production. Maintain Your Weight: Maintaining a healthy BMI helps control androgen and insulin levels. Reduce Carbohydrates: Insulin levels are increased in people with a high-carbohydrate diet. For further information about PCOS, reducing risks, and what you can do to support a healthy pregnancy, please feel free to schedule an appointment with Toronto Naturopathic Doctor, Dr. Courtney Holmberg by calling 647-351-7282 today! References: Xu, N., Kwon, S., Abbott, D. H., Geller, D. H., Dumesic, D. A., Azziz, R., … Goodarzi, M. O. (2011). Epigenetic Mechanism Underlying the Development of Polycystic Ovary Syndrome (PCOS)-Like Phenotypes in Prenatally Androgenized Rhesus Monkeys. PLoS ONE, 6(11), e27286. Joan C. Lo, Seth L. Feigenbaum, Gabriel J. Escobar, Jingrong Yang, Yvonne M. Crites, Assiamira Ferrara. Increased Prevalence of Gestational Diabetes Mellitus Among Women with Diagnosed Polycystic Ovary Syndrome. Diabetes Care Aug 2006, 29 (8) 1915-1917; DOI: 10.2337/dc06-0877 Rose McDonnell, Roger J Hart. Pregnancy-related outcomes for women with polycystic ovary syndrome. Womens Health (Lond). 2017 Dec;13(3):89-97. doi: 10.1177/1745505717731971 Chaoba Kshetrimayum, Anupama Sharma, Vineet Vashistha Mishra, and Sunil Kumar. Polycystic ovarian syndrome: Environmental/occupational, lifestyle factors; an overview. J Turk Ger Gynecol Assoc. 2019 Dec; 20(4): 255–263. doi: 10.4274/jtgga.galenos.2019.2018.0142 Berg, T., Silveira, M. A., & Moenter, S. M. (2018). Prepubertal Development of GABAergic Transmission to Gonadotropin-Releasing Hormone (GnRH) Neurons and Postsynaptic Response Are Altered by Prenatal Androgenization. The Journal of Neuroscience, 38(9), 2283–2293.


    Polycystic Ovarian Syndrome (PCOS) is one of the leading medical conditions now impacting women of reproductive age, and can also have substantial impacts on a woman’s physical and emotional well-being. We’ve already covered symptoms and diagnostic testing of PCOS here, but let's dive deeper into one key hormonal disruption that seems to be particularly troublesome for my patient population – hyperandrogenism. ​Hyperandrogenism is common in PCOS, often seen as elevated testosterone and DHEA levels on blood work. And while these two hormones are often seen as synonymous when evaluating total androgenic burden, there is a significant difference between the two. Testosterone and DHEA are both classified as androgenic hormones, however some women with PCOS may have elevated testosterone, with normal DHEA levels, and vice versa. You also don't have to have cysts on your ovaries to present with hyperandrogenism (in fact, only about 20% of women with high androgens have cystic ovaries), and cysts on your ovaries don't always mean you’ll have high androgens. Have I lost you yet? High androgens are often to blame for many symptoms seen in PCOS, including Long menstrual cycles or irregular ovulation patterns Hair growth in areas not common in women, such as the chin, chest, nipples and navel Hair loss Acne and oily complexion Where Do Androgenic Hormones Come From? There are two primary sources of androgenic hormones in women: the adrenal glands, and the ovaries. The adrenal gland is responsible for producing DHEA and makes up on average ~ 25% of our overall androgen production. The ovaries, on the other hand, are responsible for producing testosterone. Small amounts of testosterone production is normal and necessary. In fact, I often see women with low testosterone present with depression, extreme fatigue and an overall low effect. In healthy women, the granulosa cells in the ovaries transform testosterone into estrogen to help maintain proper hormone balance. There is also a third androgenic hormone produced by both the adrenal gland and the ovaries called androstenedione. An imbalance in androstenedione levels is sometimes found in women with PCOS. Lastly, it's worth mentioning the role of 17-OH progesterone, which is not an androgenic hormone but is commonly elevated in PCOS. If you’re presenting with PCOS-like symptoms, but blood work is normal, it's worth having this hormone tested, as it can convert directly into androgens in the periphery. How Is Hyperandrogenism Managed? Of course, management for hormones always begins with testing to determine where (and if) there is an imbalance. Next, the cause of the imbalance needs to be identified. In some women, their hormonal imbalance could be highly processed western diets, lifestyle choices (heavy alcohol, sugar, caffeine), and/or a lack of exercise. For others, it may be genetic (some research suggests we’re born with it). More updated research looks at the role of oxidative damage and the influence of the microbiome on hormones. It is vital that the root causes of high androgen production be addressed. Treatment plans should always involve the following to support hyperandrogenism: Reductase inhibitors – certain herbs and vitamins can reduce the functioning of an enzyme known as 5-alpha-reductase. This enzyme is responsible for converting testosterone into dihydrotestosterone, which may produce symptoms up to 2.5x stronger than testosterone alone and is highly associated with androgenic alopecia. Antioxidants – resveratrol, vitamin D and NAC are a few of my favourites. More and more evidence is pointing at chronic inflammation as an important factor in metabolic syndrome, insulin resistance, and PCOS/diabetes. These antioxidants help reduce oxidative stress, optimize egg quality, and support healthy ovulation. Blood sugar stabilization – diet and exercise are key to supporting blood sugar. It’s not about extreme restrictions, but more so about learning which foods are most likely to spike blood sugar levels and replacing them with foods from the same category to help support steady blood sugar levels. Weight management – about 50% of testosterone is made in adipose tissue in women. Weight loss will help reduce androstenedione’s conversion of testosterone levels in the periphery. ​It is worth noting that PCOS research is still ongoing. While there is still much to be learned, much information has been obtained to help develop effective treatments that do not require hormone replacement (i.e. the birth control pill). Addressing hormonal imbalances associated with PCOS, also supports an overall risk reduction to comorbidities seen with PCOS, like cardiovascular disease and diabetes. For further information about PCOS, or to find out if you may have hyperandrogenism, contact Dr. Courtney Holmberg, Naturopathic Doctor in Toronto at 647-351-7282 to schedule an appointment today! Sources:


    For decades, the gut and brain were looked at as two separate entities. What we now know is that this couldn’t be further from the truth. Modern research is discovering that mood hormones play a direct role in the mechanisms of digestion (challenging the thought, are truly just ‘mood’ hormones), and even more interestingly, the microbiome. If you’ve ever had a ‘gut-wrenching’ experience or felt ‘butterflies’ when stressed, you’re likely no stranger to the influences stress can have on the way our digestive tract feels. However, have you ever stopped to think about why this happens, and how? The Vagus Nerve The vagus nerve is one of the longest nerves in the human body, with direct communication between the medulla oblongata (part of the brain stem responsible for autonomic control) and the stomach and colon. It is argumentatively the most important regulator of our ‘rest and digest' nervous system. The vagus nerve sends signals to the muscles of the stomach, encouraging it to move food into the small intestine. It also sends information back to the brain about the state of our digestive system. What’s of great interest to modern research is the role of the vagus nerve in the treatment of mood-related disorders, such as clinical depression. There is preliminary evidence showing that vagal nerve stimulation may be an important treatment option for treatment-resistant depression, PTSD and even inflammatory bowel disease (due to the ability to reduce inflammatory cytokines) (1,2). Furthermore, research is now suggesting the role of the microbiome in benefiting mood and anxiety may come from its effects on vagal nerve tone (3). Gut microorganisms are capable of producing and delivering neuroactive substances such as serotonin and gamma-aminobutyric acid, which act on the gut-brain axis. Preclinical research in rodents suggested that certain probiotics have antidepressant and anxiolytic activities (3). The research even goes as far as to show that stress exposure directly disrupts the microbiome in a way that increases the development of immune-mediated colitis (4). Lastly, the vagus nerve may also play a role in weight gain due to its influence on the hormones that control satiety and appetite (5). Diagnosing Gut Conditions and Problems When diagnosing gut conditions, it's always important to determine whether the issues could be related to various signals being sent from the brain, or vice versus. This is why determining the underlying causes is essential rather than just treating the symptoms. For instance, you may be experiencing frequent heartburn even though you are eating regularly and avoid foods that are excessively spicy or high in acids. Upon investigation, we discovered you have been under an excessive amount of stress at work. By properly supporting stress and inherently improving vagal nerve communication of gastric emptying, your bouts of heartburn may start to subside and disappear. Gut-Brain Connection Common Symptoms The body can present with a variety of symptoms when there is something wrong with the gut-brain connection. Some of the more common symptoms may include, but are not limited to: Insomnia Headaches Decreased sex drive Depression and/or anxiety Difficulty concentrating Excess weight gain or weight loss Lack of energy Increased sadness or anger Difficulty relaxing Poor memory recall Procrastinating Starting bad habits (Smoking, Excessive Drinking, etc.) Of course, there can also be numerous other underlying causes of the symptoms listed above. However, they should never be ignored. If you start to notice something is wrong, particularly with the presentation of new digestive symptoms under high states of stress (or vice versa), it’s best to see your Naturopathic Doctor to discuss ways you can support the gut-brain connection. Lastly, it’s important to remember that communication is a two-way street. While the research now concluded that IBS is not a stress-induced condition (just as many people with high-stress report IBS symptoms as those with less stress), we now know that stress can worsen your state of digestive health, and a poor state of digestive health and worsen your mental health. For more information about the gut-brain connection, or to find out what is causing your gut problems, please feel free to schedule an appointment with Dr. Courtney Homberg, Naturopathic Doctor in Toronto, by calling 647-351-7282 today! References: Evrensel A, Ceylan ME.The Gut-Brain Axis: The Missing Link in Depression.Clin Psychopharmacol Neurosci. 2015 Dec 31;13(3):239-44. Bonaz B, Sinniger V, Pellissier S.Vagus nerve stimulation: a new promising therapeutic tool in inflammatory bowel disease.J Intern Med. 2017 Jul;282(1):46-63. Carabotti M, Scirocco A, Maselli MA, Severi C. The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems. Ann Gastroenterol. 2015 Apr-Jun;28(2):203-209. Gao X, Cao Q, Cheng Y, Zhao D, Wang Z, Yang H, Wu Q, You L, Wang Y, Lin Y, Li X, Wang Y, Bian JS, Sun D, Kong L, Birnbaumer L, Yang Y. Chronic stress promotes colitis by disturbing the gut microbiota and triggering immune system response. Proc Natl Acad Sci U S A. 2018 Mar 27;115(13):E2960-E2969. Hagemann D, Meier JJ, Gallwitz B, Schmidt WE. Appetite regulation by ghrelin - a novel neuro-endocrine gastric peptide hormone in the gut-brain-axis.Z Gastroenterol. 2003 Sep;41(9):929-36.


    Calories in versus calories out were the de facto weight loss equation for decades. To lose weight, you simply reduce the number of calories consumed while increasing the number of calories used. However, the simple equation that we have adhered to as part of a healthy lifestyle may have actually been hindering our weight loss efforts. As our understanding of health and nutrition improves, so does what we know about the simple calorie equation – and this knowledge is changing the plate of the modern diet. 1. Not all calories are created equal. ​ One reason why strictly counting calories can be an ineffective way to lose weight is that not all calories are good calories. While the energy content of calories is essentially the same in that they are an equal unit of energy, calories derived from whole foods are more effectively processed by the body than those found in processed foods. In other words, where a particular calorie comes from will have varying effects on hunger, hormones, and weight. It is not just processed foods that can determine the value of a calorie. Calories obtained through healthy fats, proteins, and whole foods, like fruits and vegetables, can positively impact metabolism, curb hunger, and help optimize hormones. However, the same quantity of calories obtained from processed foods or sugar is metabolized more quickly and less effectively, resulting in increased hunger and hormone imbalance. 2. Food labels do not tell the whole story. The second reason that we do not see significant weight loss results from calorie counting comes down to the science of determining caloric content. For instance, in the United States, the Federal Food and Drug Administration allows manufacturers a fair amount of latitude in labeling precision – up to a 20% margin of error. What this means for consumers is that the food we eat may have more calories than is indicated on the label. 3. How we digest calories differs from person to person. The third reason that solely monitoring how many calories we consume is ineffective comes down to how calories are processed by the body. Historically, it was believed that we all used calories the same way and that is partially true. However, an individual’s basal metabolic rate (BMR) – the number of calories one needs simply to maintain voluntary and involuntary bodily functions, like respiration and circulation – will be greatly influenced by factors such as age, weight, and overall health. Hormones may also play a key role in how we digest and use calories. Insulin resistance, for instance, plays a crucial role in whether we store or use the calories we consume. Men and women also process calories differently – a factor often overlooked by conventional weight loss guidelines – which means that blanket recommendations may be ineffective. For more information and guidance concerning your metabolic health and wellness, please contact your Toronto naturopathic doctor, Courtney Holmberg, ND, at 647-351-7282 to schedule a consultation today.


    According to a new study presented by Dr. El-Salhy at the United European Gastroenterology week in Spain, fecal microbial transplants (FMT) may significantly improve the pain and distress caused by irritable bowel syndrome, if transplants come from what has been termed a 'super-donor'. ​ The double-blind, randomized control trial study found that 75-89% of recruits aged 18-75 receiving 30-60 g of endoscope-administered feces into the duodenum donated the same day from a human 'super donor' reported significant benefits in their overall IBS symptoms after 3 months, with no long term adverse effects (1). Slightly greater benefits were observed in the patients receiving higher dose transplants and/or repeat transplants (2). Furthermore, Dr. El-Salhy suggested that preliminary results show 90-95% of the patient who responded are still well 1 year later, and 50% are 'cured' (3). While the cause of IBS remains unknown, many researchers suggest a correlation to the plethora of bugs that exist in our gut, also known as our microbiome. Fecal transplants have become of interest since research shows little sustained benefits to the use of oral probiotics for gut repopulation (as confirmed by microbiome testing) (4). Our guts are like fingerprints, and research suggests our digestive tracts are resistant to recolonization with probiotics for this very reason (4). In fact, some research suggests the recovery of our microbiome following antibiotics may actually be impaired by probiotic use, whereas FMTs produce a rapid and complete recovery within a matter of days (5). There's even some research showing FMTs may reduce the occurrence of SIBO in mice (6). Fecal transplants have been so successful in the management of infectious diarrhea, that the Infectious Disease Society of America has updated its guidelines to include fecal microbial transplants as a primary treatment method for the management and prevention of multiple-reoccurrence C. Difficile infections (the most common health-care-associated infection seen in hospitals)(7). What's even more promising is that medium size clinical trials are also demonstrating oral encapsulated fecal transplants do not show inferior outcomes to those delivered by colonoscopy, suggesting oral transplants may be an equally effective and less invasive intervention for treatment-resistant C. Difficle (8,9). The key to success, according to El-Salhy, is the use of donated feces from a 'super host'. The donor in the trial was young, healthy, and active, had been breastfed, had a nutritious diet, took no regular medications, was a nonsmoker and had taken antibiotics only a few times. This naturally poses issues with sourcing donors for a larger-scale therapeutic application of this research, as well as the reproducibility of the study results, knowing no two microbiomes look the same. At this point, fecal microbial transplants are not FDA or Health Canada-approved and are therefore not available to the public as a therapeutic intervention. Furthermore, El-Salhy's evidence is contradictory to numerous other studies conducted on FMTs. A recent meta-analysis (comparing data across multiple trials) shows there was no statistically significant difference in IBS outcomes between patients receiving FMTs and controls (10), concluding further research must be done on the efficacy of fecal transplants before it can be recommended as a therapeutic intervention for microbiome-related gut disorders. To learn more about microbiome testing, supportive diets, and recovery, schedule a consult with Toronto Naturopathic Doctor, Dr. Courtney Holmberg, ND today at 647 351 7828, or by booking online here. References:


    Adrenal fatigue is a functional condition which can occur as a result of stressors in the body. We’re quick to identify with emotional stress, but we often forget that stress can also come from physical and environmental stressors. Adrenal fatigue occurs when the adrenals release higher levels of hormones into the body than normal as a response to a continuous or persistent stimulus, resulting in an output of these hormones being greater than the production, and ultimate fatigue of the glands. They are considered fatigued since they are essentially drained of their active and stored hormones, and need time to recover. Yet, recovery is limited and difficult when we continue to lead a busy and stressful lifestyle (which is what ultimately caused the problem in the first place). Rather than slowly starting to recover, the adrenals remain drained and strained. Furthermore, we add aggravators like limited and/or poor quality sleep (which prevents rebuilding and recovery), processed foods, alcohol and cigarettes (which create physical stressors to the system) and high caffeine intake to deal with the fatigue (which creates a further draining of the gland by increase cortisol output). As you can imagine, the ongoing “fight or flight’ response of our nervous system is often accompanied by higher anxiety levels or an ongoing and unexplained sense of dread. Both of these conditions can affect numerous systems in the body. For instance, blood pressure rates are elevated, our beneficial microbiome shuts down, and our morbidity and mortality rates climb as a result of ongoing, unmanaged stress. ​ Other side effects we can experience are problems with our sleep cycles and lowered immune response to fight illnesses and diseases. Not getting sufficient amounts of deep sleep further feeds our stress levels, affects our cognitive abilities, and much more. As you can see, adrenal fatigue can be the start of other health-related problems in our bodies. What are the symptoms of adrenal fatigue? Symptoms can present in many different ways, depending on whether the cortisol is persistently elevated, or if your adrenal glands have hit an exhaustion phase. The most commonly reported symptoms include: 
- fatigue
 - never waking to feel rested
 - sleep disruption 
- moods: anxiety, depression, irritability 
- gastrointestinal symptoms
 - weight gain/difficulty losing weight 
- decreased thyroid function

 Adrenal fatigue patients will feel like they are in a constant state of illness, lethargic or "feeling gray". Suffering this type of listlessness, they become dependent on coffee, caffeine or other stimulants to get through the day, which ultimately exacerbates the underlying issues. How Is Adrenal Fatigue Treated? There are several different methods that can be used to address and treat adrenal fatigue. One option is to reduce and/or eliminate primary sources of stress from your life or find outlets to offload some of that stress. Some of the best strategies tend to be yoga and meditation. Yoga twice weekly for 60 mins has been shown to be as effective as Prozac in clinical trials for the management of anxiety and depression. Meditation has been shown to lower stress hormones in the body by over 60%. Interestingly, exercise can both support and worsen adrenal fatigue, depending on the level of exhaustion. If the adrenals are acutely stressed and are hyper-responding, low to moderate-intensity exercise can help burn up the overproduced hormones and return the nervous system to a more relaxed state. In this case, exercise is helpful. However, when the adrenal gland has hit levels of exhaustion (meaning stress hormone output is suboptimal and the adrenals are no longer properly responding), high-intensity exercise can cause a further worsening of the deficit. This is where lower impact, lower intensity exercise would be of more benefit. Yes, all of you high-intensity-exercising-burnt-out young ladies, that means you! Another option is the use of natural remedies that can help the body better process the hormones released during times of stress. These remedies block the natural defensive response to perceived stress, as well as better metabolize cortisol, adrenaline, and norepinephrine to minimize their long-term effects. Lower stress hormone output places less demand on the adrenals over time, and therefore the adrenals become less drained and fatigued. For further information about adrenal fatigue, and which treatments could be beneficial for you, please feel free to contact Dr. Courtney Holmberg, ND at 647-351-7282 to schedule an appointment today!


    ​​​​​​The thyroid gland is a small butterfly-shaped organ that is responsible for some vital roles in the body, from controlling our metabolism to regulating our brain development. It also influences our heart rate, body temperature, muscle strength, body weight, and even cholesterol levels. The thyroid gland makes up part of the endocrine system, which is a combination of glands that produce, store, and release hormones into the bloodstream for the purposes of cellular communication. The three main hormones involved in thyroid function are TSH (thyroid stimulating hormone), T4 (triiodothyronine), and T3 (thyroxine). ​ Unfortunately for some, the thyroid ceases proper functioning and a whole host of symptoms often emerge. Determining what treatment will be best to treat a thyroid hormone imbalance begins by first determining the root cause of the dysfunction. The most common causes of thyroid dysfunction include: ​ - Deficiencies in iodine, selenium, and iron, leading to inadequate production of thyroid hormone - Poor conversion of inactive to active thyroid - High reverse T3 causing competitive inhibition of active hormone - Poor supply of hormones from primary failure of the thyroid gland - Drug-induced by the following medications: amiodarone, nitroprusside, sulfonylureas, thalidomide, interleukin, lithium, perchlorate, and interferon-alpha therapy (1) - Autoimmunity attacking the gland and/or receptors (Hashimoto's or Graves’ Disease) There are two primary thyroid hormone imbalance types: an overproduction of thyroid hormones, called hyperthyroidism; and an underproduction of thyroid hormones, called hypothyroidism. Hypothyroidism is marked by a decrease in Triiodothyronine and thyroxine (T4 and T3) hormones and a rise in thyroid-stimulating hormones. A person diagnosed with hypothyroidism may experience increased sensitivity to cold, hair loss, weight gain, muscle weakness, unrelenting fatigue, lethargy, constipation, and irregular menstrual bleeding. The autoimmune-induced form of hypothyroidism is known as Hashimoto’s Disease. Hyperthyroidism is marked by an increase in triiodothyronine and thyroxine (T4 and T3) hormones and a drop in thyroid-stimulating hormones (TSH). A person diagnosed with hyperthyroidism may experience changes in appetite, mood swings, insomnia, heat intolerance, heart palpitations, diarrhea, weight loss, and hand tremors. The autoimmune-induced form of hyperthyroidism is known as Grave’s Disease. Whether you have been diagnosed with hyper or hypothyroidism, knowing if it is autoimmune-related is important. In essence, autoimmune disorders cause the body to attack itself by releasing antibodies to destroy self-tissue, ultimately disrupting hormone production. If your thyroid condition is related to an underlying autoimmune disorder, treatment should include management of the autoimmune disorder as well as addressing the thyroid hormone imbalance. Testing for Autoimmune Thyroid Conditions Fortunately, determining whether or not your thyroid hormone imbalance is caused by an autoimmune disorder is relatively simple. A blood test can help determine the presence of antibodies, indicating autoimmunity. Thyroid Stimulating Immunoglobulin (TSI): this immunoglobulin looks identical to thyroid-stimulating hormones, the stimulating hormone responsible for regulating T4 and T3 hormone production. When anti-TSI is present, an overproduction of T4 and T3 occurs, causing Grave’s Disease. Anti-thyroid Peroxidase (Anti-TPO): Thyroid Peroxidase is an enzyme that facilitates the movement of iodine into the thyroid gland to help produce hormones. If anti-thyroid peroxidase antibodies are present, the body can no longer move iodine properly, and triiodothyronine and thyroxine hormones cannot be produced. The presence of anti-thyroid peroxidase is seen in 83% of Hashimoto’s patients, and 53% of Graves patients (2). Anti-thyroglobulin: Iodine attaches itself to thyroglobulin — a protein formed from the amino acid tyrosine — to make the Triiodothyronine and thyroxine hormones. When anti-thyroglobulin antibodies are present, the thyroid is missing an essential protein necessary for thyroid hormone production. The presence of anti-thyroglobulin generally indicates that the thyroid condition is autoimmune-based, creating hypothyroid symptoms. Furthermore, it’s important to note that some people present with mild (or subclinical) hyper or hypothyroid symptoms before the TSH, T3, and T4 become abnormal. This can be a result of antibody presence. Just because you’ve been told your “thyroid hormones” are normal, it does not rule out the presence of autoimmunity. If you have symptoms, your antibodies should be assessed. Treatment Options Several treatment options have been shown to improve symptoms related to autoimmune thyroid hormone imbalance disorders. Ashwagandha: An 8-week study of patients with hypothyroidism found that taking 600 mg of ashwagandha root extract daily led to significant improvements in thyroid levels, compared to placebo. If fact T4 and T3 levels increased by 19.6% and 41.5% respectively, and TSH decreased by 17.5% (3). It also helps reduce stress, leading to better T4 to T3 conversion (3). However, ashwagandha can exacerbate hyperthyroid symptoms, and should not be used in graves disease (4). Myo-inositol: a naturally occurring sugar that helps regulate several hormones including insulin and TSH, shown by research to significantly reduce both anti-thyroid peroxidase and anti-thyroglobulin antibodies. Selenium: This trace mineral (found in high concentrations in Brazil nuts) has been shown to reduce anti-thyroid peroxidase antibodies in Hashimoto’s patients. It can also be taken as a supplement. Natural Desiccated Thyroid: If the gland has stopped functioning, replacement of the hormone will be necessary. Natural desiccated thyroid (NDT) is a glandular therapy taken from porcine sources, containing a 4:1 ratio of T4: T3. Some feel superior on this product to T4 therapies like Synthroid or levothyroxine, because of the T3 contents (which pharmaceutical interventions do not contain). This is a prescription-only therapy and should be discussed with your Naturopathic doctor to see if it's the right option for you. Vitamin D: found in fatty fish, like salmon, and supplemental vitamin D, in combination with other treatments, like levothyroxine, can reduce thyroid antibodies. It's important to understand the cause of thyroid dysfunction before treatment is initiated. For example, jumping to thyroid hormone replacement would be preemptive if the cause of the nutrient deficiency. Furthermore, if the gland has unfortunately failed, spending time with herbs and minerals will only delay the inevitable need for hormone replacement (Natural Desiccated Thyroid, or synthetic T4: Synthroid, levothyroxine, etc). For more information about thyroid hormone imbalance treatment options, and to discuss the use of Natural Desiccated Thyroid as an option for your thyroid management, please contact your Toronto Naturopathic Doctor, Dr. Courtney Holmberg at 647-351-7282 to schedule an appointment today.


    The gnawing, unrelenting discomfort and bloating of indigestion. Most have felt it, whether brought on by spicy food, greasy meals, alcohol or just simply overeating. Or maybe it's pain after eating. Food comes in, and the stomach begins to cramp, leaving you doubled over in pain. The occasional occurrence will usually resolve on its own, but if it's becoming chronic, you’re likely frequenting the pharmacy shelf with little relief. So you head to the natural food aisle or health food store. Digestive enzymes promise to fix everything from bloating to flatulence to heartburn relief. However, understanding how digestive enzymes work helps narrow down when to use them, and when to avoid wasting your dollars. What are digestive enzymes? Digestive enzymes break down the nutrients from the foods we eat into their smaller components, in order to allow for their absorption by the body through the small intestinal lining. Think of food as a string of pearls, and enzymes as the scissors that chop up that string into individual pearls, which can then be absorbed by the body. Humans produce enzymes, but we also obtain them from some of the foods we eat. The human body secretes enzymes from the main areas of digestion: the mouth, the stomach, the small intestine, and the pancreas (the largest producer). There are several different types of digestive enzymes, each with its own role in digesting certain types of foods. Among these enzymes are: Proteases and peptidases: help break down proteins Lipase: breaks down fats Nuclease: breaks down nucleic acids Amylase: breaks down carbohydrates In some instances, the production of these enzymes declines or stops altogether. The most common example of this would be lactose – our body slows or stops the production of the lactase enzyme, and as a result, we cannot break down and absorb the lactose sugar. Branch chain sugars ending up in our colon can lead to bacterial fermentation and gas, bloating, and sometimes stool changes. Enzyme deficiencies can slow the rate of digestion, resulting in food breaking down slower and nutrients not being absorbed. The symptoms that results are what are commonly known as “indigestion”. When to use them Whether our bodies are not producing enough enzymes due to age or disorder, supplementing our diets with enzymes may provide relief for digestive discomfort. Various disorders that benefit most significantly include cystic fibrosis, pancreatitis, and pancreatic cancer. Furthermore, digestive enzyme deficiencies, like lactase deficiency, would benefit from taking lactase-containing enzymes to aid the proper breakdown of lactose, when consumed. Taking an alpha-galactosidase enzyme can also reduce the discomfort felt from eating beans or complex carbohydrates. However, little evidence supports the use of enzymes for other common concerns like irritable bowel syndrome and acid reflux/heartburn. Often, the root cause of these concerns is not enzyme deficiencies, and so supplementing digestive enzymes provide little relief, despite the label claims. It's also important to remember that not all enzymes are made equally. Some enzymes are sourced from plants, while others may come from animal sources. Ensure to read the label, and check that the enzyme required for your needs is found on the label. Sourcing enzymes naturally Fortunately, many of the foods we eat already contain the supplements we need. Adding these foods, among others, to your diet can help provide the relief you need naturally: Pineapple: contains digestive enzymes called bromelain, which is part of a protease group of enzymes that help our bodies digest proteins. Sometimes pineapple can prove to be acidic for people with sensitive stomachs. Fortunately, bromelain is available as a dietary supplement but does have anti-platelet properties so is not recommended for individuals taking a blood thinner. Papaya: not only contains protease to help digest proteins but also papain. Papain helps break down proteins into amino acids. It’s important to make sure papaya is ripe and uncooked when you eat it. Papain is also available as a supplement and has been shown to relieve symptoms associated with IBS. Mango: contains amylase, which helps break down carbs into sugars. Honey: packs a power punch of helpful enzymes including diastases, amylases, invertases, and proteases. In addition to the enzymatic benefits, raw honey can soothe upset stomachs, and provide relief from heartburn and indigestion. Banana: contains amylases and glucosidases — both of which help break down starch into digestible sugars. Bananas are also a great source of dietary fibre, which can aid digestive health. Avocado: contains lipase, which helps break down fat molecules into glycerol and smaller fatty acids. The pancreas produces lipase on its own, but a lipase supplement can ease digestion — especially after a high-fat meal. Other enzyme-packed foods include kefir, ginger, kiwifruit, miso, kimchi, and sauerkraut. Adding some or all of these foods to your diet can improve your digestive health and relieve symptoms of everyday discomfort. Should you require a higher concentration of enzymes beyond that found in food, talk to your naturopath to find out if and what digestive enzyme supplement may be best for you. If you would like more information about managing your digestive health or naturopathic medicinal treatments, please feel free to contact Dr. Courtney Holmberg, ND at 647-351-7282 to schedule an appointment today.


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

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