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

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

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

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

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

There have been several studies and research conducted over the years on the topic of whether depression and taking a birth control pill are related. A very recent study was published this year on the topic and is making headlines, as some of you may already know. But before discussing some of its findings, it is important to first understand how the pill works, and discuss its efficacy, side effects, and potential risks on your mental and physical well-being. Birth control pills are the most commonly prescribed form of contraception to young females in North America. They contain a variety of different active and inactive ingredients. Among the more common ones are progestin, synthetic progesterone, and estrogen. The pills can contain a combination of these hormones in various dosages, or just consist of a single hormone. Ingesting synthetic hormones alters your body’s natural hormonal balance, levels, and production, ultimately preventing ovulation and subsequent ability to conceive. The estimated probability of pregnancy during the first year of perfect use of the pill is 0.3% if taken at the exact same time every day, and a dose is never missed. However, actual rates of pregnancy with oral contraceptives are more like 9-11% in their first year of use [1]. Furthermore, an estimated 51% of unintended pregnancies happen while using a birth control pill [3], suggesting the failure rate is high. Furthermore, as a result of this natural hormone imbalance, it also affects responses within the brain, which causes altered psychological and physical responses. For instance, some of the more common side effects that have been reported from women taking oral contraceptives include: Water Retention Weight Gain Yeast Infections Overeating Weight Loss No Appetite Erratic Changes in Emotions Sense of Helplessness/Sadness Reduced Sex Drive Lack of Energy Problems Concentrating Increased Risks for Cervical and Breast Cancers The University of Copenhagen Study on Depression and Birth Control This recent study contained a large sample population, consisting of 1,061,997 female subjects, who were aged 15 to 34. In addition, none of these women had experienced any form of depression or other psychiatric/psychological problems prior to starting birth control. To help determine the effects of taking oral contraceptives, the researchers monitored whether subjects were diagnosed with depression or started a new antidepressant prescription throughout the study. The study sample was also divided into two groups, where one set of women would take some form of birth control including: Transdermal Patches Progestin-Only Pills Vaginal Rings Combination Pills Levonorgestrel IUD The other group of women would not use female birth control during the study. At the conclusion of the study, researchers compared the number of women who developed depression during the study period in both groups. The findings were as follows [3]: 131,178 women had obtained a prescription for antidepressant medications at some point during the study period. 23,077 women were newly diagnosed with depression. Subjects, aged 15 – 19 had the highest ratio of antidepressant medications and depression diagnoses. Relative risks for first-time use of antidepressants were as follows: Combined oral contraceptives: 23% increased risk Progesterone-only pill: 35% increased risk Contraceptive Patch: 100% increased risk Vaginal Ring: 60% increased risk Progesterone IUD: 40% increased risk Based on these findings, the study concluded there was evidence that birth control use and depression were related. However, future studies conducted at other research facilities have resulted in varying findings. For instance, a 2007 study also found an increase in depression from subjects taking birth control, while another one in 2012 did not find a correlation between the two. Natural Alternatives for Birth Control If you are worried about the potential risks and side effects of oral contraceptives, there are several natural alternatives available. Forms of hormone-free birth control methods include: Male Condoms Female Condoms Diaphragms Cervical Caps A conversation I often have with my patients is about the use of a hormone-free intrauterine device made from copper. While the study did not assess the use of a hormone-free intrauterine device, if you have a history of depression, or have previously experienced low moods on a birth control pill, this may be an effective alternative for you. Of course, it comes with its own risks and side effects, so always have a full discussion with your Medical Doctor or Naturopath to find an option that is right for you. For more information about these and other natural alternatives, please feel free to contact Dr. Courtney Holmberg ND at 647.351.7282 or access the online schedule HERE today to arrange a consultation appointment at her naturopathic clinic in Toronto. ​ References: Trussell, James (2011). "Contraceptive efficacy". In Hatcher, Robert A.; Trussell, James; Nelson, Anita L.; Cates, Willard Jr.; Kowal, Deborah; Policar, Michael S. (eds.). Contraceptive technology (20th revised ed.). New York: Ardent Media. pp. 779–863 Unintended pregnancy in the United States. Sept 2016. https://www.guttmacher.org/fact-sheet/unintended-pregnancy-united-states Charlotte Wessel Skovlund, MSc; Lina Steinrud Mørch, PhD; Lars Vedel Kessing, MD, DMSc, Øjvind Lidegaard, MD, DMSc, et al. Association of Hormonal Contraception With Depression. JAMA Psychiatry. 2016;73(11):1154-1162.

The Ketogenic diet is an extremely popular diet amongst the weight loss community. Originally brought to light for its promising research in epilepsy management, it quickly became a hopeful solution for those looking to quickly shed pounds without massive caloric restrictions. But like any trend, we must weigh all the pros and cons, while simultaneously accounting for the long-term impacts on our health. First off, let's break down what the ketogenic diet actually involves. The premise of the diet focuses on reducing carbohydrates to force the body into an anabolic (breakdown) state, known as ketogenesis. Ketogenesis is a metabolic process our bodies enter into when sources of glucose (both dietary and stored) cannot keep us with metabolic needs, forcing the body to produce ketone bodies from adipose tissue (aka fat) to use for energy in place of sugar. As you can imagine, this is favourable for weight loss for several reasons. In addition to fat now being used as fuel, the blood sugar staying so low sharply drops insulin secretion, which further reduces the stimulus for fat and sugar storage. As long as the body remains deprived of carbohydrates, ketosis is sustained and weight loss continues. There’s also the concept of something called ‘super fuel’, meaning ketone bodies produce more usable ATP molecules (aka energy) to the heart, muscles, and brain than glucose, resulting in the additional energy and mental focus many people report while in ketosis.1 ​ Studies are showing very promising results for epilepsy, and have been well documented and proven to be effective for rapid weight loss, with initial weight loss of up to 10 lbs in 2 weeks or less.1 However, literature exceeding 2 years of use is lacking, and some studies raise show some red flags are raised within 3 months into ketosis that may have more concerning health implications long-term. Let’s dive further into what those risks are. #1: Vitamin and mineral deficiencies. While the ketogenic diet does help to eliminate certain unhealthy foods, like refined sugars and carbohydrates, it also eliminates fruits and other vegetables that contain carbs. It’s no surprise that fruits and vegetables provide a primary source of the vitamins and minerals the body needs for optimal health, in addition to being high in antioxidants. Now, there are also two ways to approach ketosis – one that maintains a high low-carb vegetable intake and a balanced amount of saturated fats, and one that involves eating bacon and hamburger patties at every meal. All that aside, Harvard health highlights the most common nutrients depleted on a ketogenic diet are electrolytes like sodium and potassium, magnesium, calcium and b vitamins.2 Supplementation is an option, but no concrete evidence shows supplementing vitamins and minerals provides the same health outcomes as getting them from nutritious food, so I always suggest food first. #2: Ketosis, digestive health, and the microbiome. Beyond constipation that comes from a lack of grains & fibre that result from a keto diet, the impacts of a long-term high fat/low carb diet on the microbiome are of my greatest concern. Without dietary fibre, people on the Keto diet can experience either diarrhea or constipation, as well as bloating. Sometimes these are transient side effects, and other times not. However, dietary fibre is the key ingredient to a microbiota-accessible carbohydrate (or MAC) diet. Fibre is what feeds our flora, which they then convert it short-chain fatty acids like butyrate that provide us with the endless health benefits we hear about surrounding probiotics. Without fibre, our flora suffers, which is demonstrated in the literature looking at all fibre-deficient diets, including FODMAP and gluten-free diets.3 Even short-term ketosis reveals a “statistically significant increase in Desulfovibrio spp, a bacterial group supposed to be involved in the exacerbation of the inflammatory condition of the gut mucosa-associated to the consumption of fats of animal origin”.4 To vastly oversimplify the research, it seems the benefits of the ketogenic diet on the microbiota as a whole are unclear. Some studies show a favourable increase in beneficial flora, while others show the opposite. In summary, the take-home seems to be that an overall decrease in microbial diversity is seen in those following a ketogenic diet.3 #3: The Keto diet can worsen athletic performance, and maybe even long-term weight loss Losing fat sounds great when you want to get fit. However, recent research found that in a ketogenic state, study participants performed worse on running and high-intensity cycling tasks after being on the Keto diet for four days, compared to participants that spent the same four days following a high-carb diet.5 The conclusion of the study suggests “short-term low-carbohydrate, ketogenic diets reduce exercise performance in activities that are heavily dependent on anaerobic energy systems. These findings have clear performance implications for athletes, especially for high-intensity, short-duration activities and sports”.5 Therefore, you may wish to again if you’re considering using the ketogenic diet to fuel your HIIT workouts every morning. Recent studies have also highlighted that “ketogenic diets impair glucose and lipid metabolism in mice” 6, suggesting that long-term use may actually alter metabolic activity. There may also be concerns around the “yo-yo” effects of the Keto diet (where people lose fat, only to gain it back, and oftentimes more) on long-term metabolism. #4: Following the Keto diet long-term can increase the risks of chronic diseases. Since fat consumption is essential to fueling ketogenesis, participants need to consume foods with high-fat content to maintain a ketogenic state. As a result, a rise in cardiovascular risk factors is often seen. Some literature shows an increase in blood pressure and cholesterol levels in ketogenic states, which is something I also see demonstrated in blood work for my current patients on a ketogenic diet. A study from the American College of Cardiology found that people following the Keto diet long-term had a higher risk of developing atrial fibrillation, a common heart rhythm disorder that also increases risks of heart disease and strokes.7 Other literature also highlights adverse effects including hepatic steatosis, hypoproteinemia, and kidney stones.1 In conclusion, it’s safe to say the use of a ketogenic diet needs to be evaluated on a case-by-case basis, and there calls for a collection of better long-term safety research before the diet can be considered as an ongoing intervention. With your microbiome always at the forefront of my mind, short-term ketosis may result in some favourable shifts in weight and metabolism, but offsetting the long-term impacts should be discussed with your ND. To find out more about the right dietary adjustments for your gut and metabolism, please feel free to contact Toronto naturopathic doctor, Dr. Courtney Homberg at 647-351-7282 to schedule your appointment today. Sources: Masood W, Annamaraju P, Uppaluri KR. Ketogenic Diet. [Updated 2020 Dec 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. https://www.health.harvard.edu/staying-healthy/should-you-try-the-keto-diet#:~:text=Other%20potential%20keto%20risks%20include,and%20C%2C%22%20McManus%20says. Reddel S, Putignani L, Del Chierico F. The Impact of Low-FODMAPs, Gluten-Free, and Ketogenic Diets on Gut Microbiota Modulation in Pathological Conditions. Nutrients. 2019;11(2):373. Published 2019 Feb 12. doi:10.3390/nu11020373 Tagliabue A, Ferraris C, Uggeri F, Trentani C, Bertoli S, de Giorgis V, Veggiotti P, Elli M. Short-term impact of a classical ketogenic diet on gut microbiota in GLUT1 Deficiency Syndrome: A 3-month prospective observational study. Clin Nutr ESPEN. 2017 Feb;17:33-37. doi: 10.1016/j.clnesp.2016.11.003. Epub 2016 Dec 18. PMID: 28361745. Wroble KA, Trott MN, Schweitzer GG, Rahman RS, Kelly PV, Weiss EP. Low-carbohydrate, ketogenic diet impairs anaerobic exercise performance in exercise-trained women and men: a randomized-sequence crossover trial. J Sports Med Phys Fitness 2019;59:600-7. DOI: 10.23736/S0022-4707.18.08318-4 Li Y, Yang X, Zhang J, Jiang T, Zhang Z, Wang Z, Gong M, Zhao L, Zhang C. Ketogenic Diets Induced Glucose Intolerance and Lipid Accumulation in Mice with Alterations in Gut Microbiota and Metabolites. mBio. 2021 Mar 30;12(2):e03601-20. doi: 10.1128/mBio.03601-20. PMID: 33785628; PMCID: PMC8092315. https://www.acc.org/about-acc/press-releases/2019/03/06/10/29/low-carb-diet-tied-to-common-heart-rhythm-disorder

The gut is home to a wide array of microbiota that influences various interactions within our bodies. These microbes also regulate gut functioning, digestive processes, absorption of essential vitamins and minerals, and so on. When the gut is not functioning correctly, our bodies suffer. Long-term effects of an unhealthy gut include increased risks of metabolic problems, depression, obesity, cancer, autoimmunity, liver disease, ulcers, heart disease, and other illnesses and health problems. ​ Of particular interest is the Paleo diet, which restricts the consumption of all grains (bread, rice, pasta, cereals, quinoa, etc) including whole grains, as well as legumes. The most notable limitation of this diet is the loss of soluble and insoluble fibres found within these foods. Let’s explore this important nutrient first. Part of what keeps the gut functioning correctly is ensuring it gets plenty of fibre. Fibre is good for the gut microbiota. They feed off it and thrive as they should. So naturally, one should always consider the impacts on long-term impacts on gut health when making dietary changes. Besides benefiting gut functioning, fibre also helps lower cholesterol, regulate blood sugar levels, and assists with better weight management. Healthy gut functioning also helps keep TMAO (Trimethylamine N-oxide) levels low, which is a molecule generated via microbial metabolism linked to increased levels of cardiovascular disease, as well as hypothesized neurological disorders. As a whole, what occurs when someone follows the Paleo diet long-term is the levels of good gut microbiota decrease and the amount of TMAO in the body increases. This is primarily contributed to the increase in protein consumption through meat and fish and the removal of whole grains and legumes. While some fibre is consumed through various fruits and vegetables, two essential microbiomes in the gut are not getting fed. Bifidobacterial thrives from starches found in bread and grains, while Roseburia thrives from beta-glucans found in oats and barley. A recent research study followed different control groups that stayed on the Paleo for a year. There were three different groups – a control group, a strict Paleo group, and a pseudo-Paleo group. At the end of the study, those in the strict Paleo group and the pseudo-Paleo group had a noticeable decrease in good gut microbiota. The participants did get plenty of fibre from fruits and vegetables. Yet, they were not getting the right balance of fibre to feed every type of healthy gut microbiome. There was also a noticeable increase in TMAO levels in study participants.1 Another study conducted by the same researchers, looked at the short-term microbiome shifts in the gut while on the Paleo diet. That study concluded that short-term use of the diet did not have long-term shifts in the microbiome.2 In conclusion, the studies show that following the Paleo diet long-term can reduce the healthy gut microbiota and increase TMAO levels. It doesn't mean that a Paleo diet can’t be followed long-term, but ensuring to modify and account for missing fibre sources is important. If you want more about dietary impacts on your gut, as well as effective approaches that are not carb-free or starch-free, please feel free to contact Toronto naturopathic doctor, Dr. Courtney Homberg at 647-351-7282 to schedule your appointment today. Sources: Genoni, A., Christophersen, C.T., Lo, J. et al. Long-term Paleolithic diet is associated with lower resistant starch intake, different gut microbiota composition and increased serum TMAO concentrations. Eur J Nutr 59, 1845–1858 (2020). Janeiro MH, Ramírez MJ, Milagro FI, Martínez JA, Solas M. Implication of Trimethylamine N-Oxide (TMAO) in Disease: Potential Biomarker or New Therapeutic Target. Nutrients. 2018;10(10):1398. Published 2018 Oct 1. Genoni A, Lo J, Lyons-Wall P, et al. A Paleolithic diet lowers resistant starch intake but does not affect serum trimethylamine-N-oxide concentrations in healthy women. Br J Nutr. 2019;121(3):322-329.

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: https://pubmed.ncbi.nlm.nih.gov/29413100/ https://link.springer.com/article/10.1007/s12011-019-01694-7 https://pubmed.ncbi.nlm.nih.gov/29080462/ https://pubmed.ncbi.nlm.nih.gov/16965241/

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. https://www.immunology.org/news/report-reveals-the-rising-rates-autoimmune-conditions 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] https://www.gutmicrobiotaforhealth.com/the-gut-microbiota-clock-the-close-connection-between-gut-microbiota-dietary-patterns-and-the-circadian-rhythm/ [2] https://pubmed.ncbi.nlm.nih.gov/29166320/ [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378297/

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.