Authored by Dr. Barrett

Start planning now

• As our days are getting shorter and the cool air is starting to blow in it is all too common that we stop our summer time exercise routines. 
• Think about what exercise routines have worked for you in the past and start planning now. 

Embrace Outdoor Activities

• Dress appropriately: Invest in cold-weather workout gear, including moisture-wicking layers, insulated jackets, gloves, and thermal leggings.
• Start slowly and gradually increase the intensity as your get used to the cold weather.
• Winter sports: Try activities like ice skating, cross-country skiing, fat tire biking, snowshoeing, or even sledding for a fun and active winter experience.

Find Indoor Classes

• If the cold just isn’t for you then sign up for a gym or get a home gym set up. 
• Maybe you pause your gym membership in the summertime to take advantage of the warm weather. Now it’s time to get back to the gym!
• If you find group exercise classes keep you motivated seek out some in your area. 

Set Goals and Create a Routine

• Set specific fitness goals for the fall and winter months to keep you motivated and accountable. 
• Establish a workout routine and schedule it into your day to make exercise a consistent habit.

Make it Social

• Exercising with a friend or partner can make it easier to keep up the habit. 
• Join a local sports league or recreational group to stay active while socializing.

Stay Safe

• Wear reflective gear when it’s darker out.
• Use tracks on your shoes to prevent slipping on the ice. There are so many types you can use. I find I can continue running well into winter and early in the Spring with the proper tracks on my sneakers. 
• Avoid outdoor exercise during extreme cold or icy conditions to prevent accidents and injuries.

Remember that staying active during the fall and winter is not only beneficial for your physical health but also for managing stress and improving mood, which can be particularly important during the darker and often busier holiday seasons. 

Authored by Dr. Aidanne

IBS is considered a “diagnosis of exclusion” which means that it is typically given once the more serious conditions that affect the structure or function of the GI tract are ruled out (ie. IBD, celiac, endometriosis, or hypothyroidism).

What is normal?

In order to understand potential IBS triggers, knowledge of normal digestive function is key. 

Even before we eat, our body is setting our system up for success by making digestive enzymes and acid in response to the smells and sights we experience while cooking. When we finally take a bite, chewing both manually grinds foods and stimulates saliva production that contains enzymes to break carbohydrates down. Swallowing then sends our food down the esophagus and into the stomach where acid and digestive enzymes await to to break it down further. From there, the small intestine is responsible for absorbing micronutrients. The large intestine sucks out all the water to form our stool and is home to our gut microbiome.

So what can lead to IBS?

Although there may be more at play and the exact causes of IBS are uncertain, I commonly encounter these four triggers in my practice:

1.) Gut Motility Issues & Mental Health

Our autonomic nervous system has two main branches, the parasympathetic (aka “rest and digest”) and sympathetic (aka “Fight or flight”). You may recall that during a period of intense stress, your bowel movements were not normal. Maybe you experienced a loose stool due to overactive nerves or were unable to pass one for multiple days. This is due to the significant impact that stress has on our vagus nerve. The vagus nerve is responsible for stimulating digestive juices and driving muscle contractions (aka peristalsis) that keep our bowels moving smoothly. When we eat on the run or do not allow our body time to calm before eating we impair our digestive function. 

How we eat and when we eat can also play a role. IBS can often occur if meals are skipped, too large, or if we’re eating sporadically. Also, the plants we eat throughout the day provide us with fiber needed to regulate our bowel motility. The gut loves consistency! 

Also, there is a well established bidirectional set of signals that pass between the brain and our gut tissue. Ninety percent of our serotonin is produced in the gut, so when these levels are low it can not only impact our mood but also impede peristalsis and increase sensitivity of the nerves of the gut. Addressing both mental health concerns, neurotransmitter imbalances and gut motility is an effective IBS management strategy. 

2.) Microbiome Imbalances

Balance and diversity are essential when it comes to the community of bacteria, viruses, and fungi that live in our large intestine. Either insufficient or overgrown levels of these microbes can cause disruptions to bowel transit time and symptoms such as gas and bloating. Insufficiency is more common in cases of looser stools and the yeast Candida is a common culprit for those living with constipation, bloating and flatulence. Fiber is important here as well, as it not only helps to bulk up the stool but can nourish our gut bacteria. 

A stool sample is the best way to gain insight into possible imbalances in the large intestine. 

3.) Foods Sensitivities

When we eat foods our bodies do not tolerate well, the undigested food fragments that make their way through our GI tract activate our gut related immune system. This can cause a lot of local irritation and inflammation which serve to make the gut tissue more sensitive. 

Common food sensitivities that contribute to IBS symptoms include gluten, dairy, eggs, soy, nuts, alcohol, and foods rich in FODMAPs. 

FODMAPs are fermentable sugars that some individuals do not break down well. When undigested, FODMAPs draw water into the intestines resulting in looser bowel movements and increased peristalsis. FODMAPs often cause bloating from our gut microbes feasting on them and producing gas as a byproduct. Although a low FODMAP diet is not meant to be implemented long term, it can provide relief while other factors are being ruled out. 

4.) Genetics & Enzyme Deficiencies

Enzyme deficiencies can be inherited. The classic example is an inability to produce lactase which is needed to break down lactose. This then leads to lactose intolerance which can trigger diarrhea, bloating, gas and abdominal pain if someone eats dairy. Sucrase, isomaltase and alpha-galactosidase can all impact ones ability to break down sugars. Supplementing with digestive enzymes or herbs to support enzyme production can be helpful in these cases. 

5.) Medications

Common medications that can worsen or trigger IBS symptoms include NSAIDs, antibiotics, antidepressants, PPIs, opioids, hormonal medications, etc.

​
References:

• Patel N, Shackelford K. Irritable Bowel Syndrome. [Updated 2022 Oct 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534810/
  
• Wald A. Clinical Manifestations and Diagnosis of Irritable Bowel Syndrome in Adults. UpToDate. Updated July 20, 2022. Current through July 2023. 

Authored by Dr. Aidanne

Authored by Dr. Barrett

Abdominal bloating and distention are two of the most commonly reported gastrointestinal concerns. Bloating is a feeling of tightness, pressure or fullness in your abdomen. You may even notice a visibly distended abdomen and clothing can feel tight. While it is not usually a serious medical concern, chronic or severe bloating can significantly impact one's quality of life. In this article, we will explore the various causes of abdominal bloating.





Causes of bloating:

Gas Production:

• Gas production occurs naturally as a part of digestion. Bacteria live in our intestines and fermented leftover carbohydrates. If there is too much fermentation happening excessive gas can be produced. This gas is eventually passed as flatulence. 
• SIBO (small intestine bacterial overgrowth) is just what it sounds like, an overgrowth of bacterial in the small intestines. This causes excessive bloating and discomfort with most meals. This gas can become trapped for long periods of time before being passed. 

Swallowing Air:

• Swallowing air unintentionally is a common cause of abdominal bloating. This can happen when talking while eating, chewing gum, drinking through a straw, or consuming carbonated beverages. Individuals who are anxious or nervous may also swallow air more frequently, exacerbating bloating symptoms.
  

Stress:

• Stress can impact the movement and contractions of your gastrointestinal tract. It can either speed up or slow down the movement of food through your intestines, leading to changes in bowel habits and potential bloating.
  
• Stress can lead to the redirection of blood flow away from the digestive system to support other parts of the body preparing for the sympathetic or "fight or flight" response. This reduced blood flow can hinder the optimal functioning of the GI tract and cause bloating.
  

Food Sensitivities/Intolerances:

• Food intolerances and sensitivities occur when the body has difficulty digesting certain substances, such as lactose, fructose, or gluten. In these cases, the undigested components can ferment in the intestines, leading to gas production and bloating. Common culprits include dairy products, wheat-based products, beans, and certain fruits.
  

Menstruation:

• Bloating and water retention can occur during the menstrual cycles due to hormonal fluctuations. This monthly occurrence can lead to abdominal discomfort and swelling.
  

Bowel Obstruction or Serious Conditions:

• In rare cases, abdominal bloating can be a symptom of more serious conditions, such as bowel obstruction, ovarian cysts, uterine fibroids, or even certain cancers. If bloating is accompanied by severe pain, sudden weight loss, or persistent changes in bowel habits, medical attention should be sought immediately.
  

Therapeutic options:

Dietary Modifications:

• Identify and avoid trigger foods that can cause bloating, such as carbonated drinks and certain artificial sweeteners.
  
• Avoid food intolerances. These are often identified by using an elimination diet. 
  
• Consider trying a low-FODMAP diet, which restricts fermentable carbohydrates that may cause gas and bloating in some individuals. Note: this diet is for temporary relief and should not be followed longer than 6 weeks. 
  

Chew Slowly and Avoid Swallowing Air:

• Eat meals at a slower pace to reduce the amount of air swallowed during eating.
  
• Avoid using straws and chewing gum, as they can lead to swallowing excess air.
  

Microbiome Support:

• Consuming probiotic-rich foods or taking probiotic supplements can promote a healthy balance of gut bacteria and improve digestion, potentially reducing bloating.
  
• Eating prebiotic fibers can help support a healthy microbiome. Foods high in prebiotic fibers include garlic, onions, bananas, apples, and oats. 
  

Deep Belly Breathing:

• Deep breathing activates the parasympathetic nervous system, which is responsible for promoting a "rest and digest" response in the body. This helps relax the muscles in the gastrointestinal tract, facilitating better digestion and reducing bloating.
  
• Deep breathing can aid in the release of trapped gas from the digestive system. When you take slow, deep breaths, you stimulate movement in the intestines, which may help relieve gas and bloating.
  

Herbal teas:

• Certain herbal teas such as peppermint, ginger, fennel and chamomile can aid in digestion and help to reduce bloating. 
  

Apple Cider Vinegar (ACV) and Bitter Herbs:

• ACV contains acetic acid, which is thought to stimulate the production of digestive enzymes, potentially aiding in the breakdown of food and improving digestion.
  
• Bitter herbs such as dandelion, gentian, chamomile, and artichoke can help stimulate the production of digestive enzymes and the release of bile to improve digestion. These herbs may also have carminative properties, meaning they help reduce gas and gloating in the digestive system. 
  
  • These herbs can be consumed as a tea or tincture or incorporated into dishes.
    

Regular physical activity:

•  Regular exercise can help improve bowel motility and prevent constipation, both of which can reduce bloating.
  

Manage Stress:

• Stress and anxiety can worsen bloating symptoms. Practicing relaxation techniques, such as deep breathing, meditation, yoga, or mindfulness, can help reduce stress and its effects on digestion.
  

Resources:

• Lacy BE, Cangemi D, Vazquez-Roque M. Management of Chronic Abdominal Distension and Bloating. Clin Gastroenterol Hepatol. 2021 Feb;19(2):219-231.e1. doi: 10.1016/j.cgh.2020.03.056. Epub 2020 Apr 1. PMID: 32246999.
  

​​

Authored by Dr. Aidanne

Did you know that:

• Men on average live 5.9 years less than women (1)
• Nearly 51% of men over the age of 20 have hypertension (2) 
• The top 6-leading causes of death in males of all origins include heart disease, cancer, unintentional injuries, chronic respiratory conditions, stroke and diabetes (3)
• 40% of men over the age of 20 are obese (2)

It’s important that men feel supported when it comes to their health and here is where disease prevention is key! 

Naturopathic medicine is aptly suited to help manage chronic conditions including, but not limited to:

• Male Factor infertility
• Cardiovascular Disease & Associated Risk Factors (ie. Hypertension, High cholesterol, Diabetes, Stroke, Atherosclerosis, etc.)
• Benign Prostatic Hyperplasia (BPH)
• Erectile Dysfunction (ED)
• Prostate Cancer

Male Factor Infertility:
Women often feel the full weight of responsibility when it comes to failure to conceive, but of course it takes two to tango! The shape, quality, and motility of sperm are all important in successful conception. Various factors such as hormone imbalances, excess alcohol consumption, unmanaged stress, environmental pollutant exposure, poor diet with a high glycemic index, smoking, etc. can all negatively affect a man’s sperm leading to entirely male-based infertility in 20-30% of cases. (4) 

Cardiovascular Disease, BPH & ED:
I plan to discuss these concerns together not because they are medically similar, rather because they are intricately related. 

BPH is characterized by growth of the prostate tissue which can put pressure on the bladder leading to lower urinary tract symptoms of frequent urination, waking at night to urinate (aka. Nocturia), intermittent stream, straining, incontinence and increased urgency. Although the mechanism is not known with certainty, it is hypothesized that the intermittent wakings at night to urinate may negatively affect blood pressure possibly contributing to hypertension. (5) Also, it is well established that both obesity and Type 2 Diabetes are risk factors for BPH in part because they contribute to a state of inflammation and increased oxidative stress. See below for how to combat this! 

The integrity of our blood vessels, blood pressure, and heart rate also play a key role in the process of arousal that is negatively impacted in ED. (6) It is also common for those living with Type 2 diabetes to experience ED as a side effect of neuropathy in the peripheral tissues. (7)

Prostate Cancer:
Prostate cancer (PC) was the leading form of new cancers diagnosed in Minnesota in 2020 and fortunately the relative 5-year survival rate is 97.1% when caught early. (8,9) PC is more prevalent in African American men, and the most significant risk factors include age and family history. That said, diet plays an integral role in supporting favorable PC outcomes and maintaining remission.  

A Naturopathic Approach:
The fundamental pillars of health that keep us well are the diet and lifestyle. All of the conditions above would benefit from quality sleep, smoking cessation, regular movement and a diet with reduced red meat, dairy, sugar, and alcohol. (10) 

Any form of movement is beneficial to a man’s health. With regard to fertility, moderate interval training has been shown to support sperm count and semen volume, where cycling can have a detrimental effect. (11) Aerobic training positively challenges our cardiovascular system and strength training can help regulate hormone production and metabolism. Greater than one hour a week may reduce severe nocturia by 34% compared to staying sedentary. (12) Ideally we would be aiming for a mix of activities and intensities, but consistency is the most important factor!

High dietary sugars increase oxidation and stress on the body that can increase inflammation of the prostate and also slow sperm motility. The latter contributes to male factor infertility. 

A generally anti-inflammatory diet includes increased amounts of vegetables, deeply pigmented fruit (ie. Berries, pomegranate, cherries, etc.), tomato, omega-3 rich fish & plants, and green tea. All of these foods are high in dietary anti-oxidants which help to offset oxidative stress and its resulting inflammation.  Lycopene is a nutrient that comes from red-colored fruits and veggies, and is particularly supportive to the prostate. (13)

Nutrients and herbs also have a supportive role to play! To improve fertility outcomes, targeted antioxidants such as CoQ10, Vitamin C, Vitamin D, and Zinc can enhance sperm counts and prevent fragmentation of the sperm itself. In cases of cardiovascular disease, BPH, ED and PC I often recommend herbs and nutrients to balance testosterone, increase circulation, balance blood sugars and ease the stress response. Some of my favorites include Saw palmetto, Nettle, Berberine, Pygeum, Reishi, Ginkgo, L-arginine, and Vitamin C. 

I also often recommend routine bloodwork to ensure that blood sugars are well regulated, markers of cardiovascular inflammation are within normal, and hormone levels are optimal.

Ready to take your health into your own hands? It would be a pleasure to work with you!

Disclaimer: This information is meant for educational purposes only and should not be used as a replacement for professional medical advice.

References:
1. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20220831.htm  
2. https://www.cdc.gov/nchs/fastats/mens-health.htm   
3. https://www.cdc.gov/minorityhealth/lcod/men/2016/all-races-origins/index.htm
4. https://www.ncbi.nlm.nih.gov/books/NBK562258/ 
5. https://pubmed.ncbi.nlm.nih.gov/19359054/ 
6. Sexual Activity in Patients with Cardiovascular Disease. UpToDate. Updated June 7, 2022. 
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9286480/
8. https://gis.cdc.gov/Cancer/USCS/#/AtAGlance/ 
9. https://seer.cancer.gov/statfacts/html/prost.html 
10. Risk Factors for Prostate Cancer. UpToDate. Updated October 10, 2022.
11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5675222/ 
12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342314/ 
13. https://www.cancer.gov/about-cancer/treatment/cam/hp/prostate-supplements-pdq#_16 

Authored by Dr. Barrett

These microbes do many things for us. So much in fact that without them it would be difficult for us to survive. They digest certain fibers turning them into short chain fatty acids that we need for our digestive health. They communicate with our immune cells and control how we respond to infections. New research indicates that there is a strong connection between our brain health and our microbiome. The microbiome is also considered to be an endocrine organ because it exerts influence on distant organs and pathways (1).

Oral contraceptive pills (OCPs) also known as birth control, impacts the health of our microbiome. The hormones that are naturally produced in our bodies and the hormones that we take orally both impact the composition of our microbiome (2). It makes sense that taking hormones orally would alter the microbiome. For millions of years we were only exposed to hormones that we produce naturally. It’s only been in the last 70 years that we started taking hormones by mouth. 

Folks who take oral birth control (hopefully) know that when they take antibiotics the birth control pill can become much less effective. One hypothesis for this effect is that antibiotics dramatically alter the microbiome where a significant amount of estrogen metabolism takes place (3).

Unfortunately the birth control pill can also increase your risk of inflammatory bowel disease. In two large studies it was found that women who use oral contraceptives for over 5 years had a significantly increased risk for developing inflammatory bowel disease, particularly Crohn’s (4).

It’s not just the gut microbiome that’s impacted by birth control pills. The vaginal microbiome is also altered and the risk of vaginal yeast infections is increased in people taking birth control pills (5).

We need more research into the microbiome but we know enough now to know that taking oral hormones impacts the health of our microbiome. 

In general here are some ways to support a healthy microbiome:

• Consuming fiber daily from a variety of sources. Aim for 30-35g daily. 
• Limit processed foods and high sugar foods in your diet.
• Consume fermented foods.
• Limit your use of antibiotics.

References:

1. Qi X, Yun C, Pang Y, Qiao J. The impact of the gut microbiota on the reproductive and metabolic endocrine system. Gut Microbes. 2021 Jan-Dec;13(1):1-21. doi: 10.1080/19490976.2021.1894070. PMID: 33722164; PMCID: PMC7971312.
2. Hua X, Cao Y, Morgan DM, Miller K, Chin SM, Bellavance D, Khalili H. Longitudinal analysis of the impact of oral contraceptive use on the gut microbiome. J Med Microbiol. 2022 Apr;71(4). doi: 10.1099/jmm.0.001512. PMID: 35452382.
3. Adlercreutz H, Pulkkinen MO, Hämäläinen EK, Korpela JT. Studies on the role of intestinal bacteria in metabolism of synthetic and natural steroid hormones. J Steroid Biochem. 1984 Jan;20(1):217-29. doi: 10.1016/0022-4731(84)90208-5. PMID: 6231418.
4. Khalili H, Higuchi LM, Ananthakrishnan AN, Richter JM, Feskanich D, Fuchs CS, Chan AT. Oral contraceptives, reproductive factors and risk of inflammatory bowel disease. Gut. 2013 Aug;62(8):1153-9. doi: 10.1136/gutjnl-2012-302362. Epub 2012 May 22. PMID: 22619368; PMCID: PMC3465475.
5. Spinillo A, Capuzzo E, Nicola S, Baltaro F, Ferrari A, Monaco A. The impact of oral contraception on vulvovaginal candidiasis. Contraception. 1995 May;51(5):293-7. doi: 10.1016/0010-7824(95)00079-p. PMID: 7628203.

 ​

Authored by Dr. Aidanne

What is Acne?
Acne refers to the inflammation and irritation of the hair follicle that results in trapped oils (also known as “sebum”), skin cells, and various bacteria known as C. acnes that populate the skin surface. When trapped, this mix of materials can produce what we know as pimples that are characteristic of acne. Pimples can come in many forms and show as either white heads, black heads, raised bumps or cysts deep under the skin surface. They are commonly located on the face, arms, chest and back. Whether it is showing as a single pimple or more widespread, the pressure of a clogged follicle can become very painful and lead to scarring.

What Causes Acne?
I hear this question frequently in clinic, and there is no one catch all answer for everyone. Some people may have a single key root cause while others may have a combination of triggers. This is where blood work and functional lab testing are useful to guide proper management of acne.

As with most conditions, acne has both modifiable and unmodifiable risk factors. Modifiable factors are those that are within our control to change. Unmodifiable are those that are out of our control.

Here are some of the most common modifiable triggers for acne:

• Hormonal Changes (ie. estrogen, testosterone, DHT, DHEA, etc.)
• Diet & Food Sensitivities
• Blood Sugar Regulation (ie. Glucose, insulin)
• Stress (ie. Cortisol)
• Nutrient deficiencies

Here are some of the most common unmodifiable triggers for acne:

• Age
• Genetics / Family History

Hormones:
Androgens and androgen precursors are hormones that can lead to acne when elevated. These include testosterone, DHEA, and DHT. The latter has nearly four times the potency of testosterone. These hormones increase the amount of sebum that is produced, which can clog the pores more frequently leading to increased acne. Also, fluctuations in estrogen and progesterone throughout the menstrual cycle can also worsen acne.

Diet & Blood Sugar Regulation:
You may have experienced a pimple or two after eating a lot of baked goods or sugary foods. When we eat foods that are high on the glycemic index, our blood sugar levels go up. Given insulin’s main job is to remove sugars from the blood stream and send them to the tissues to be burned for fuel, a high blood sugar level causes insulin to rise. Elevated insulin levels can drive the production of androgens, thus leading to increased sebum production.

Whey is a protein found in dairy that can trigger acne for a couple of reasons. When consumed regularly, food sensitivities can result in GI related inflammation that weakens the skin barrier. Many people do not tolerate dairy well, and this is often due to either its lactose or whey content. Secondly, consuming whey leads the body to make a chemical called Insulin Like Growth Factor (IGF-1) which triggers cells to grow. What is one of the main hormones that causes tissue growth? Yet again, the answer is testosterone!

Stress:
When stressed, the body makes various hormones to drive the “fight or flight” response. The adrenal glands are the primary source of two key hormones in this process, DHEA and Cortisol. DHEA can be converted into testosterone in the body, and cortisol spikes increase circulating blood sugars so that the body has quick fuel if it needs to act quickly.

Adaptogens are a group of botanical medicines that help the body “adapt” to the stress response and improve stress resiliency. I often include an adaptogen as part of an acne protocol.

Nutrient Deficiencies:
Those living with acne have been found in the literature to be more likely to have low Vitamin A, Vitamin D, Vitamin E and zinc status compared to their counterparts. Where it’s hard to say whether these deficiencies are a main cause acne, their supplementation has been shown to improve the intensity of acne, reduce inflammation, and help skin cells heal.

Authored by Dr. Barrett

Authored by Dr. Aidanne

Up to 7% of women do not experience any symptoms but most women will present with cyclical or chronic pelvic pain, painful intercourse, intense menstrual cramps, fatigue, back pain, bloating, nausea, and infertility (nearly 50%). This pain can severely impact one’s quality of life, mood and sense of self. 

The inner lining of the uterus is meant to respond to estrogen with changes in the menstrual cycle. When found outside of the uterus, this endometrial tissue can wreak havoc on organs and systems due to both its physical presence as well as the inflammatory response it exerts on the local nerves when exposed to estrogen. Up to 7% of people do not experience any symptoms but most people will present with cyclical or chronic pelvic pain, painful intercourse, intense menstrual cramps, fatigue, back pain, bloating, nausea, and infertility (nearly 50%). This pain can severely impact one’s quality of life, mood and sense of self. 

The risk of endometriosis goes up if you have a family history, early onset of menstruation, late menopause, heavy and short menstrual cycles, or have never had a pregnancy. 

The goal of supporting a person with endometriosis is to support clearance of estrogens to lower their effect on the system, alleviate pain, and reduce inflammation. Often women are told that they simply have heavy periods, and they’ll have to either live with it or go on birth control. Although birth control can provide relief, there are other options available. Let’s dive in!

Diet:
​
As elevated sugar in the diet can increase our estrogen levels, minimizing excess carbohydrates and sugar is key in reducing pain symptoms of endometriosis. 

Since we eliminate hormone metabolites through our stool, ensuring that bowel movements are well-formed and easy to pass is important to avoid reabsorbing estrogen. Fibers such as those that come from ground flax seed can help with this and can also reduce estrogen in the blood stream by increasing the level of sex hormone binding globulin (SHBG). 

Antioxidants are needed to offset the oxidative stress that occurs with inflammation. Foods that had a mother and are colorful are typically antioxidant rich, such as green leafy veggies, berries, red onion, carrots, etc. 

Finally, the cruciferous family of veggies (ie. broccoli, cauliflower, Brussels sprouts, etc.) contain compounds in them called indol-3-carbinol (I3C) and diindolylmethane (DIM) which help metabolize estrogens to the lower potency, 2-hydroxyestrone form. 

Food is medicine!

Lifestyle:

The best lifestyle factors to improve symptoms of endometriosis include movement, reducing exposure to environmental estrogens also known as xenoextrogens, and using castor oil packs. 

Movement can have a positive impact on all body systems. In this case, it encourages the muscles to utilize the sugars within our blood stream. When blood glucose levels are reduced, so is the hormone needed to take them out of the blood stream known as insulin. High levels of insulin dampen our liver’s ability to produce SHBG which allows estrogen to roam more freely in the blood stream and exert its effect on bodily tissues. 

Xenoestrogens can come from various sources such as plastics (BPA, BPS), polychlorinated biphenyl (PCB), phthalates in cosmetic products, pesticides, cigarette smoke, exhaust, chemical pollutants, etc. These synthetic estrogen mimicking components can be reduced by:

• Switching to a stainless-steel water bottle
• Buying organic where possible
• Dusting & vacuuming regularly 
• Incorporating EWG approved unscented & phthalate free cosmetic products
• Cooking with cast iron
• Using glass storage containers vs. plastic and avoiding heating plastics

Although the mechanism is not fully clear, castor oil is known to have anti-inflammatory and analgesic effects when used topically. It can be applied to the abdomen or pelvis to alleviate pain symptoms. Talk to your naturopathic doctor to learn more! 

Botanicals & Nutritional Supplementation:

Botanical & nutritional medicines can be used to support the liver in clearing estrogens, bring blood sugars into balance, and alleviate pain by reducing inflammation. 

Common recommendations would include:

• Hormone Regulators – Chaste tree verry, 
• Antioxidants – Melatonin, Resveratrol, EGCg, Pycnogenol
• Anti-inflammatories – Turmeric, Cat’s Claw, Ginger, Garlic
• Liver Supporting – Milk thistle, NAC, Burdock

A placebo-controlled study from 2013 in Brazil showed that melatonin at a dose of 10mg nightly was able to reduce daily pain scores by nearly 40% when taken for 8-weeks. This affect was attributed to melatonin’s ability to decrease both reduce pain on its own and lower levels of a protein called brain-derived neurotrophic factor (BDNF) which makes the nerves more sensitive to pain. 

A 2021 randomized control trial conducted in Iran showed that 400mg of garlic extract taken daily for 1-3 months could improve pelvic pain, low back pain, heavy menstrual bleeding, and painful intercourse. This effect was attributed to garlic’s ability to support estrogen clearance in the liver and its anti-inflammatory Allicin content. 

Interested in learning more? Let’s chat!

References:

1. Schenken, RS. Endometriosis: Pathogenesis, epidemiology, and clinical impact. UpToDate. Updated: Feb 13, 2023. Accessed: Apr 6, 2023.
2. Endometriosis. World Health Organization. Accessed from this link. 
3. Prousky, J. Textbook of Integrative Clinical Nutrition. CCNM Press. 2013.
4. Daka B, Rosen T, Jansson PA, Råstam L, Larsson CA, Lindblad U. Inverse association between serum insulin and sex hormone-binding globulin in a population survey in Sweden. Endocr Connect. 2012;2(1):18-22.
5. Ilhan M, Dereli FTG, Akkol EK. Novel drug targets with traditional herbal medicines for overcoming endometriosis. Curr Drug Deliv. 2019;16(5):386-399.
6. Schwertner A, Conceição dos Santos CC, Costa GD, et al. Efficacy of melatonin in the treatment of endometriosis: A phase II, randomized, double-blind, placebo-controlled trial. Pain. 2013;154(6):874-881.
7. Amirsalari S, Behboodi Moghadam Z, Taghizadeh Z, Jafar Abadi MN, Sabaghzadeh Irani P, Goodarzi S, Ranjbar H. The Effect of Garlic Tablets on the Endometriosis-Related Pains: A Randomized Placebo-Controlled Clinical Trial. Evid Based Complement Alternat Med. 2021 Jul 20;2021:5547058. doi: 10.1155/2021/5547058. PMID: 34335819; PMCID: PMC8315864.

Authored by Dr. Barrett

Authored by Dr. Aidanne

Since the onset of the COVID19 pandemic, researchers and medical professionals have found that the SARs-CoV2 virus can both worsen outcomes for those living with pre-existing cardiovascular disease (CVD) risk factors and increase risk in of CVD outcomes in otherwise healthy individuals.

Those living with hypertension, arrhythmias, poor circulation, diabetes, and dyslipidemia are significantly more susceptible to blood clots, stroke, and inflammation of the heart (aka pericarditis) after infection with COVID19.

But how does the SARs-CoV2 virus exert this effect?

To thrive in a host environment, a virus must first find a molecule on the cell surface to hijack in order to gain entry to the cell. In the case of SARs-CoV2, it hijacks the ACE2 transporter which can be found in cells of our heart, lung, kidneys, nose, mouth, and intestines causing ACE2 enzyme levels to go down. Some major roles of the ACE2 enzyme include keeping our blood pressure tightly regulated and heart beating strongly. Low ACE2 levels can therefore contribute to weakened heart contractions, poor circulation to the heart’s ventricles, and worsened diastolic hypertension.

Once entry into the cell is achieved, the virus causes a cascade of inflammation which drives the production of reactive oxygen species (ROS). ROS can be damaging to the cells, and this is especially true for the cells that line our blood vessels. Injury to the blood vessel causes the vessel walls to constrict, leading blood pressure to go up. Clotting factors also become activated in an attempt to heal the injured tissue, and platelets are made in greater numbers to help fight off the infection. Both clotting factors and platelets thicken the blood and slow circulation with goal of forming a clot. On the skin surface this process would look like the formation of a scab. To coat and reinforce the damaged blood vessel itself, cholesterol and immune cells also come together to lay a fatty steak foundation that sets off the process of atherosclerosis and plaque formation. Together, these processes increase the risk of stroke and heart attack.

Finally, the heart cells themselves can become injured after infection which can be seen from testing markers of cardiac inflammation such as D-dimer, fibrinogen, prothrombin time, and troponin T levels.

Although most people recover once the infection is cleared, some have a hard time overcoming the inflammatory response. In the short term, inflammation plays a protective role to help us fight the virus and activate the immune system. But inflammation in the long term can become detrimental and shows in the cardiovascular system as hardening of the heart muscle, atherosclerosis, altered coordination of nerve signals that regulate the heart’s rhythm, or postural orthostatic tachycardia syndrome (PoTS). There is a lot we still need to learn about what leads one person to respond so differently than another to a SARs-CoV2 infection, so hopefully future research will be able to speak to these knowledge gaps.

In the meantime, naturopathic medicine has a major role to play in supporting and preventing cardiovascular risk factors by means of dietary counseling (especially around antioxidants!), lifestyle changes, use of botanical medicines, and targeted nutritional supplementation.

Interested in learning more? Let’s chat!

References:

1. Danilczyk U, Penninger JM. Angiotensin-converting enzyme ii in the heart and the kidney. Circulation Research. 2006;98(4):463-471.
2. ​Raisi-Estabragh Z, Cooper J, Salih A, et al. Cardiovascular disease and mortality sequelae of COVID-19 in the UK Biobank. Heart. 2023;109(2):119-126.
3. Cenko E, Badimon L, Bugiardini R, et al. Cardiovascular disease and covid-19: a consensus paper from the esc working group on coronary pathophysiology & microcirculation, esc working group on thrombosis and the association for acute cardiovascular care (Acvc), in collaboration with the european heart rhythm association(Ehra). Cardiovascular Research. 2021;117(14):2705-2729. – Picture

Authored by Dr. Barrett

The figure above highlights a few hypothesized mechanisms for developing long-COVID. Today we are going to talk about the relationship between autoimmunity and COVID-19.

Autoimmune disease develops when the immune system starts attacking your own tissues. In addition to genetic factors, environmental triggers including viruses, bacteria and other infectious agents play a major role in the development of autoimmune diseases. There are several mechanisms behind these triggers that include but are not limited to molecular mimicry, bystander activation and epitope spreading. In an oversimplified nutshell there can be cases of mistaken identity (molecular mimicry), our immune system getting overexcited (bystander activation), and chronic inflammation (epitope spreading). One major hypothesis regarding COVID-19  and autoimmune disease is that SARS-CoV-2 aggravates the immune system via molecular mimicry and bystander activation. 

There are several ways that autoimmune disease and COVID-19 are interrelated. COVID-19 may trigger new onset of autoimmune disease. Conversely, people with existing autoimmune disease may be at risk for complications from a COVID-19 infection. People who experience ‘long COVID’ have higher incidence of blood markers for autoimmune disease. 

COVID-19 may trigger the development of autoimmune diseases. One study looked at patients hospitalized with COVID-19 and measured their levels of autoantibodies. Autoantibodies are antibodies that attack our own tissues. They found that approximately 50% of patients hospitalized with COVID-19 generated autoantibodies compared to just 15% of non infected individuals. This indicates that SARS-CoV-2 causes development of new autoantibodies which correlates with an autoimmune response. (1)

Patients with autoimmune diseases specifically rheumatic, IBD, and multiple sclerosis appear to be more vulnerable to severe outcomes from COVID-19 infections. One important note is that all of these conditions increase the risk of cardiovascular disease. In many of the studies, once cardiovascular disease is taken into account, the association between autoimmune disease and severe outcomes from COVID-19 isn’t as statistically significant. In a nutshell, it could be not so much the autoimmune piece that increased the risk but the cardiovascular health of the patient (2). We need more research to understand why patients with autoimmune disease may be at a higher risk for complications and severe outcomes from COVID-19.

Patients with long-COVID syndrome exhibit immune characteristics that include higher predisposition to autoimmunity. ANA is a blood marker used to diagnose autoimmune diseases. One study looked at patients who had long-COVID for one year and found a positive ANA in a significant number of patients compared to controls (3). Interestingly these patients also had a poorer antibody response to SARS-CoV-2 and more chronic inflammation. 

It's important to note that while there is evidence suggesting a connection between COVID-19 and autoimmune disease, more research is needed to fully understand the mechanisms behind this association. 

In naturopathic medicine we work to reduce triggers to the immune system, lower systemic inflammation and bring more balance to an overactive immune system. We use a variety of tools including but not limited to nutrition, botanical medicine, microbiome support, mind body medicine, hormone balancing, lifestyle medicine and targeted supplementation. 


References: 

1. Chang SE, Feng A, Meng W, Apostolidis SA, Mack E, Artandi M, Barman L, Bennett K, Chakraborty S, Chang I, Cheung P, Chinthrajah S, Dhingra S, Do E, Finck A, Gaano A, Geßner R, Giannini HM, Gonzalez J, Greib S, Gündisch M, Hsu AR, Kuo A, Manohar M, Mao R, Neeli I, Neubauer A, Oniyide O, Powell AE, Puri R, Renz H, Schapiro J, Weidenbacher PA, Wittman R, Ahuja N, Chung HR, Jagannathan P, James JA, Kim PS, Meyer NJ, Nadeau KC, Radic M, Robinson WH, Singh U, Wang TT, Wherry EJ, Skevaki C, Luning Prak ET, Utz PJ. New-onset IgG autoantibodies in hospitalized patients with COVID-19. Nat Commun. 2021 Sep 14;12(1):5417. doi: 10.1038/s41467-021-25509-3. PMID: 34521836; PMCID: PMC8440763.
2. Winchester N, Calabrese C, Calabrese LH. The Intersection of COVID-19 and Autoimmunity: What is Our Current Understanding? Pathog Immun. 2021 Mar 8;6(1):31-54. doi: 10.20411/pai.v6i1.417. PMID: 33969248; PMCID: PMC8097827.
3. García-Abellán J, Fernández M, Padilla S, García JA, Agulló V, Lozano V, Ena N, García-Sánchez L, Gutiérrez F, Masiá M. Immunologic phenotype of patients with long-COVID syndrome of 1-year duration. Front Immunol. 2022 Aug 24;13:920627. doi: 10.3389/fimmu.2022.920627. PMID: 36090973; PMCID: PMC9451924.
4. Liu Y, Sawalha AH, Lu Q. COVID-19 and autoimmune diseases. Curr Opin Rheumatol. 2021 Mar 1;33(2):155-162. doi: 10.1097/BOR.0000000000000776. PMID: 33332890; PMCID: PMC7880581.
5. Castanares-Zapatero D, Chalon P, Kohn L, Dauvrin M, Detollenaere J, Maertens de Noordhout C, Primus-de Jong C, Cleemput I, Van den Heede K. Pathophysiology and mechanism of long COVID: a comprehensive review. Ann Med. 2022 Dec;54(1):1473-1487. doi: 10.1080/07853890.2022.2076901. PMID: 35594336; PMCID: PMC9132392.

Authored by Dr. Aidanne

Recovering from a COVID19 infection can be challenging enough, let alone living with long COVID symptoms after the infection clears. Digestive upset (ie. nausea, abdominal pain, vomiting) and bowel movement changes are among the more common long COVID symptoms. If you previously lived with a happy gut, this could significantly impact your new day to day life.


And why does it happen? How does the SARS-CoV2 virus affect gut and the microbiome.


To grasp this connection, we must first understand our biology. For those who may be new to this topic, the gut microbiome refers to the community of “flora” including bacteria, yeast, and viruses that colonize our intestines. They are meant to be there in a delicate balance and serve many beneficial purposes. They help us digest our foods, absorb nutrients, keep the intestinal lining healthy, fend off other invaders that may enter the system through our environment, lower inflammation, and make neurotransmitters such as serotonin that communicate with our brain.


This community keeps our bodies running smoothly but their balance is susceptible to damage from exposures in our environment such as infectious disease-causing organisms. We want a variety of beneficial species in the intestines with no one strain becoming dominant.


Various studies have shown that the stool samples of those who have contracted COVID-19 not only have a lower variety of beneficial microbes in their samples compared to a healthy counterpart but they also have a lower quantity of beneficial flora. If you think of the GI tract as a tube that only has so much space for microbes to fill, space that is left empty by the absence of beneficial flora will be filled with more problematic or opportunistic species (ie. Candida, Clostridium, Enterobacter, etc.).


Once these species seize the opportunity to establish themselves in the system, they wreak havoc by first inducing inflammation in the intestinal tissue. This inflammation then signals to the immune cells resting in the brush border of the intestine that we have something to fight off. To kill off these invaders, these local immune cells sound the alarm to their neighbors to make what are called cytokines. These are compounds that help guide the immune response but can further the inflammatory cycle if not kept in check.


Ultimately, the inflammation from this process wears down the protective mucus barrier to the brush border. It can also weaken the bonds called tight junctions that keep the cells of the GI tract close together, and weakened tight junctions contribute to intestinal hyperpermeability or “leaky gut”. If you think of a bucket with holes in it, you can expect that a lot of water will fall through. In a similar vein, if the intestinal lining is leaky we will not be able to digest our foods or absorb our nutrients well which can further contribute to imbalances in the local flora that are not prepared to pick up the leg work in feeding on undigested foods.


To cut this cycle and help the intestinal lining heal, naturopathic medicine offers a diverse set of tools including botanical medicines, probiotics, dietary counseling, and targeted nutritional supplementation.


Are you ready to start your journey? Let’s chat!

​
References:

1. Wang B, Zhang L, Wang Y, et al. Alterations in microbiota of patients with COVID-19: potential mechanisms and therapeutic interventions. Sig Transduct Target Ther. 2022;7(1):1-15.
2. Bernard-Raichon L, Venzon M, Klein J, et al. Gut microbiome dysbiosis in antibiotic-treated COVID-19 patients is associated with microbial translocation and bacteremia. Nat Commun. 2022;13(1):5926.

Authored by Dr. Aidanne

What does testing look like?
An advanced assessment includes testing lipid levels, lipoproteins (proteins that transport lipids in the blood stream), inflammatory markers and hormones.

1) Lipids:
Lipids are fats that our body uses to make hormones, keep our skin vibrant, absorb nutrients, etc. A basic lipid panel is often run as part of routine bloodwork to screen for elevated cholesterol. This includes total cholesterol, HDL, LDL, and triglycerides. Where this is an incredibly important screening measure, it is not comprehensive for assessing overall cardiovascular disease risk.

An NMR Lipo Profile is one example of an extended lipid profile that includes the number and size of each lipid molecule. This is important because smaller lipid molecules are more likely to penetrate an inflamed blood vessel and contribute to plaque.

This test also includes measures of very low-density lipoprotein (VLDL), Apolipoprotein-A and Apolipoprotein-B. VLDL and Apo-B are known to have a high plaque producing potential, where Apo-A is cardio-protective. (2)

2) Inflammatory Markers:
Inflammation plays a leading role in the development of atherosclerosis. (3) Once the inner muscular layer of a blood vessel is irritated and becomes inflamed, it is easier for immune cells and fats to accumulate and produce plaque.

C-reactive protein (CRP) is a protein our body produces in response to inflammation in general. Where it is not specific to the cardiovascular system, it can be a useful marker to track your progress with a treatment plan. (4)

Homocysteine (Hcy) is an inflammatory marker that is more specific to the cardiovascular system. It is the byproduct of protein breakdown that is cleared out of the system with the help of folic acid and other B-vitamins. When elevated, this can be a sign that either:

1. We are not eating enough green leafy vegetables rich in folic acid, OR
2. There is a gene mutation that does not allow the body to make the MTHFR enzyme needed to convert the folic acid we gain from our diet into the methylenetetrahydrofolate (MTHF) form needed for clearing homocysteine.

3) Hormones:
Our bodies make hormones to send signals and ensure the system is operating smoothly. This process can affect how they use fats and sugars. When elevated, thyroid stimulating hormone (TSH), cortisol (the main stress hormones responsible for signaling a fight or flight response in our bodies) and testosterone can cause total cholesterol and LDL levels to rise. (6,7) A similar effect can be seen in response to depleted estrogen levels as a woman experiences menopause.(8)
Insulin is the hormone responsible for drawing sugars out of the blood stream to be burned for fuel in the tissues. When insulin is elevated, this can be a sign that blood sugar levels have been high for a prolonged period which is a potential source of inflammation in the blood vessels.

Do you have a family history of cardiovascular diseases?

Why wait to screen for your cardiovascular status?

Connect with your naturopathic doctor today!


References:

1. CDC. Heart Disease Facts | cdc.gov. Centers for Disease Control and Prevention.
2. Emeasoba EU, Ibeson E, Nwosu I, Montemarano N, Shani J, Shetty VS. Clinical relevance of nuclear magnetic resonance lipoprofile. Front Nucl Med. 2022;2.
3. Malekmohammad K, Bezsonov EE, Rafieian-Kopaei M. Role of lipid accumulation and inflammation in atherosclerosis: focus on molecular and cellular mechanisms. Front Cardiovasc Med. 2021;8.
4. Nehring SM, Goyal A, Patel BC. C reactive protein. In: StatPearls. StatPearls Publishing; 2022.
5.  Maduka IC, Neboh EE, Ufelle SA. The relationship between serum cortisol, adrenaline, blood glucose and lipid profile of undergraduate students under examination stress. Afr Health Sci. 2015;15(1):131-136.
6. Kaur H, Werstuck GH. The effect of testosterone on cardiovascular disease and cardiovascular risk factors in men: a review of clinical and preclinical data. CJC Open. 2021;3(10):1238-1248.
7. Guetta V, Cannon RO. Cardiovascular effects of estrogen and lipid-lowering therapies in postmenopausal women. Circulation. 1996;93(10):1928-1937.

Authored by Dr. Aidanne

What is Gastritis?
Words that end in the Greek derived suffix “itis” indicate a condition that involves significant inflammation. Gastritis is specifically referring to inflammation of the stomach lining. Exposure to chronic irritation over time can cause damaging changes to the gastric tissue, which can eventually lead some to experience ulceration.

Where abdominal pain, heartburn, reflux, nausea, vomiting, anemia or dark stools may be signs of gastritis, not everyone experiences these symptoms. Ultimately, this is diagnosed based on imaging studies and biopsy of the stomach (also known as endoscopy) by a gastroenterologist. (1)

Where does it come from?
This inflammation can be rooted in a few sources, including but not limited to (1,2):

• H. pylori infection
• Bacterial, viral, parasitic, or fungal infections
• Acid reflux or heartburn (chronic)
• Autoimmunity and treatment, including Crohn’s disease
• Gallbladder disease
• Radiation
• Food allergies or intolerances
• Family history
  
  

As the digestive tract is a large tube that processes foods and other substances from the outside world, lifestyle factors that can aggravate the stomach tissue should also be ruled out. A few include:

• Smoking tobacco
• Moderate to excessive alcohol use
• Long term use of certain medications (ie. NSAIDs such as Ibuprophen, etc.)
• ​Significant psychological stress

​How can naturopathic medicine help?

Diet & Lifestyle Counseling:
A key goal in managing gastritis is to lessen the impact of stress on the system, whether that be identifying foods that are irritating to your GI tract or discussing a plan to offset the stress in your life.

When our stomach lining is inflamed, our ability to absorb nutrients properly goes down and deficiencies may result (Ie. Iron, B12, zinc, vitamin C, etc.). Once the inflammation is calmed, repleting these nutrients is key to supporting overall health, immune function, mood, sleep, and energy levels. (3)

Botanical Medicine:
Botanical medicines are a valuable modality when it comes to lowering inflammation in general, especially when it is rooted in the gastrointestinal tract.

1.) Licorice:
One of my favorite botanicals to use in gastritis is licorice because it (4):

• Directly eases irritation of the GI lining
• Has been shown to heal gastric ulcers (5)
• Supports the immune system
• Has antibacterial and antiadhesive effects against H. pylori (5)
• Acts as an adaptogen, which helps improve our resilience to the physical manifestations of stress

When used for this purpose, I typically recommend licorice in the form of de-glycyrrhizinated licorice (DGL). DGL this has the glycyrrhizin compound removed, which is responsible for the blood pressure raising effect of licorice.

2.) Marshmallow, Slippery Elm & Aloe vera:
When you think of marshmallows, a puffy white sugar cube likely comes to mind. Althea officinalis is the scientific name for the marshmallow root, which is rich in a gummy substance called mucilage. Other botanicals rich in mucilage include slippery elm and aloe vera which gives them a “demulcent” or soothing action. Akin to how you would rub Aloe vera on a sunburn to ease the pain, these botanicals can be consumed as an tea or mixed in water to ease the burning symptoms of gastritis. (6)

3.) Cranberry & Mastic Gum:
If H. pylori is identified as a contributing factor by either biopsy or non-invasive tests (Ie. breath, stool, or blood testing), then Cranberry and Mastic gum are two botanical medicines that would support conventional treatment in clearing these bacteria from the system. Cranberry helps to keep the bacteria from adhering to the lining of the stomach, and mastic gum has antibacterial, anti-inflammatory, and tissue healing properties. (7,8,9)

Ready to discuss which approaches are most appropriate for you? Schedule your complimentary discovery call today!

References:

1. Azer SA, Akhondi H. Gastritis. [Updated 2022 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544250/
2. Feldman M, Jensen P. Gastritis: Etiology and diagnosis. UptoDate. Updated: July 29, 2022.
3. Gaby A. Nutritional Medicine. Second edition. Fritz Perlberg Publishing; 2017.
4. Murray MT. Glycyrrhiza glabra (Licorice). Textbook of Natural Medicine. 2020:641–647.e3. doi: 10.1016/B978-0-323-43044-9.00085-6. Epub 2020 Jul 10. PMCID: PMC7348626.
5. Wang Q, Yao C, Li Y, Luo L, Xie F, Xiong Q, Feng P. Effect of polyphenol compounds on Helicobacter pylori eradication: a systematic review with meta-analysis. BMJ Open. 2023 Jan 5;13(1):e062932. doi: 10.1136/bmjopen-2022-062932. PMID: 36604137; PMCID: PMC9827256.
6. Hoffman, D. Medical Herbalism: The science and practice of herbal medicine. Healing Arts Press; 2003.
7. Soulaidopoulos S, Tsiogka A, Chrysohoou C, Lazarou E, Aznaouridis K, Doundoulakis I, Tyrovola D, Tousoulis D, Tsioufis K, Vlachopoulos C, Lazaros G. Overview of Chios Mastic Gum (Pistacia lentiscus) Effects on Human Health. Nutrients. 2022 Jan 28;14(3):590. doi:​10.3390/nu14030590. PMID: 35276949; PMCID: PMC8838553.
8. Abdi S, Ataei S, Abroon M, Majma Sanaye P, Abbasinazari M, Farrokhian A. A Comprehensive Review of the Role of Complementary and Dietary Medicines in Eradicating Helicobacter pylori. Iran J Pharm Res. 2022 Jun 18;21(1):e127030. doi: 10.5812/ijpr-127030. PMID: 36060908; PMCID: PMC9420233.
9. Mastic: Pistacia lentiscus. Natural Medicines Database. Updated: 10/4/22. 

Authored by Dr. Aidanne

As iron is a key piece to the hemoglobin protein, low iron levels can result in symptoms of low tissue oxygen such as (1):

• Fatigue
• Shortness of breath
• Dizziness
• Headaches
• Pale skin
• Elevated heart rate
• Nail changes
• Low mood
• ​Brain fog

Where does it come from?
Risk factors for iron deficiency anemia include situations where the demand for iron is higher than the supply to the body. Common examples of this include chronic blood loss, inadequate intake of iron from the diet, poor absorption of iron through the GI tract, or all the above (1):

• Menstruation
• Pregnancy
• Gastrointestinal ulceration or bleeds
• Celiac disease
• Chronic Inflammation (i.e., Cancer, autoimmune conditions, IBD, HIV, etc.)
• Malnutrition in seniors

Testing:
If someone comes to me expressing low energy and any combination of the symptoms mentioned above, iron is high on my list of labs to order.

When assessing iron status, I like to run a complete blood count (CBC), iron panel & ferritin to get a robust picture of how the body is utilizing iron. Looking at an iron panel will show the direct level of iron in the blood stream as well as how efficiently hemoglobin is using it. If you have lived with chronically, over time a CBC will show changes in the size and shape of the red blood cells.

The human body has an incredible ability to heal and store nutrients needed for survival in times of hardship. Ferritin is the form of iron that we keep on reserves. If a CBC and iron panel look normal but the ferritin level is low, this is a warning sign that we are dipping into savings to keep our blood iron levels normal. In that case, our goal is to boost dietary iron intake and support absorption to prevent the progression to anemia.

Repleting our iron stores takes time. I often retest these values after 3-4 months of targeted dietary or supplemental efforts to ensure your body absorbs the iron properly.

Food Sources & Absorption:
Iron comes in two main forms: heme and non-heme. As “heme” is Greek for “blood,” this form of iron is found in foods that contain blood such as animal-based proteins. Non-heme refers to the iron contained in plants, which is not as easy to absorb as its counterpart. (2)
One way that we can improve the absorption of non-heme iron is by accompanying the plant with a source of Vitamin C. (2) Personally, I love to sauté chopped collards or kale and drizzle some lemon juice to garnish for dinners, or add a squeeze of lime juice to the black beans on my tacos. There are so many tasty ways to use food as medicine!

Foods rich in iron include, but are not limited to (3):

• Liver
• Fish, Lean poultry, beef, other meats
• Eggs
• Dark green, leafy vegetables
• Legumes
• Millet & Oatmeal
• Pumpkin seeds

If dietary restrictions prohibit you from eating these foods, supplementation is always an option, but should be coordinated with a health care provider to avoid side effects such as constipation , nausea, etc.

Ready to take back your energy levels? Let’s chat!
Click HERE to schedule your complimentary discovery call with Dr. Aidanne today.

​References:

1. Warner MJ, Kamran MT. Iron Deficiency Anemia. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448065/
2. Ems T, St Lucia K, Huecker MR. Biochemistry, Iron Absorption. [Updated 2022 Apr 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448204/
3. https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/ 

Authored by Lynn Salmon-Easter

Summertime brings thoughts of sunshine, carefree schedules, vacations and weekends away at the cabin. Is summer a season that replenishes and restores you? For some of us, summer simply is not a time of year that rejuvenates. As I continue to explore and deepen my understanding of being a highly sensitive person (HSP), I have come to realize summer is a season that holds challenges and triggers for me.

According to leading expert Elaine Aron’s bestselling book, “The Highly Sensitive Person," the highly sensitive trait impacts 15%-20% of the population. Being a highly sensitive person is a scientific personality trait also known as sensory processing sensitivity (SPS). HSPs are naturals when it comes to picking up on subtle cues or stimuli that other people miss. This is due to a nervous system and brain that process deeply and are more in tune with subtleties in the environment.  As a result, highly sensitive people do best with plenty of rest and downtime to regulate their nervous system and replenish their body and mind. 

Are you wondering if you might be a highly sensitive person? If so, you can take this sensitivity quiz developed by expert and sensitivity psychologist, Julie Bjelland. 

Unfortunately, it can be common for those of us that are highly sensitive to feel misunderstood and out of sync with the rhythms of mainstream society. For many years, I convinced myself summer is a season to relish and love. As I have gained greater knowledge about the genetic trait of high sensitivity, I have become more in tune with my personal needs and better acquainted with the environments that overstimulate my body, brain and nervous system. 

Last summer, I became acutely aware that heat, noise and disruptions to my daily routine are all things that stress and overwhelm my nervous system and body. With this realization, I have finally been able to make sense of the seasonal feelings of dread and anxiety that are ushered in with the season of summer for me each year. 

Personally, summer often feels like the odds are stacked against me, with high heat, humidity, noise from road construction and air conditioners plus longer days with fewer hours of sleep. These triggers can all add up to be a formula that challenges me physically and makes me feel like my mental wellness may come unhinged at any moment.

Not all highly sensitive people will find summer to be challenging. In fact, much of the population adores summer, which can make ‘summer blues’ that much more stifling. If summer makes you feel mostly miserable and everyone else seems so happy hanging out in the summer sunshine, it can can make you feel that much more isolated and out of sync with society. 

Specific symptoms of ‘summertime blues’ can look like:

• low moods 
• lack of energy or motivation
• Irritability 
• Anxiety

If your symptoms begin to include loss of appetite, weight loss, trouble sleeping, or you no longer have interest in hobbies or activities that usually excite you, please seek professional help. Summertime SAD (seasonal affective disorder) is a more serious form of ‘summertime blues’ and affects 1 out of 10 people that suffer from seasonal affective disorder.

If you struggle with low moods and lack energy during the summer months, below are some tips that have tamed my ‘summertime blues’ and blahs. I hope these tips might be helpful for you too.

Identify Your Summer Triggers 
It is not exactly known why individuals impacted by ‘summertime blues’ are affected, but it is thought increased heat, higher humidity, longer days and disruptions to routine and schedules may play a role. By identifying your personal summertime challenges, you can begin to develop a plan to manage your triggers in healthy and sustainable ways.

Create A Routine  
If you have struggled with low moods or depression personally, you will know that having a reliable routine is one of the best ways to keep depression symptoms at bay. Unfortunately, summer usually unmoors our daily rhythms and routines and can create chaos within even the most calm individuals and families. Following a consistent schedule each day of the week can assist in stabilizing your moods as well as your life.

Prioritize Sleep
With the longer days of summer, it can be challenging to get enough shut eye to stay feeling mentally well. Purchasing blackout shades or curtains can help create an environment that is conducive for sleeping more hours within a given night. For highly sensitive people, sleep is imperative and is one of the trusted ways to work through the increased information HSPs take in each day. Many sensitive individuals do best with 9-10 hours of sleep each night.

Commit to Self-Care
One of the greatest challenges highly sensitive people face is an overstimulated nervous system. As highly sensitive individuals, self-care is an essential part of our equilibrium and wellbeing. If you are highly sensitive and summer is a season that creates challenge and triggers for you, self-care practices will be imperative so you can get you through the warmer months with sanity and ease. Bodywork like massage, acupuncture, Reiki or any other type of service that nourishes you can be supportive and helpful in calming your nervous system and body. If finances limit your access to services, find creative low cost ways to support your sensitive soul. Here are a few ideas:

• Make herbal sun tea — try this lavender rooibos sun tea
• Place your feet in an ice bath 
• Keep moistened washcloths in the refrigerator or freezer to create your own chilled compresses. Add a few drops of your favorite essential oil to the washcloths before you refrigerate or freeze them. This simple addition of essential oil will elevate the experience and delight your senses.

Stay Cool
The increased heat and humidity of summer seems to inflame body, mind and emotions. Finding ways to stay cool can help temper irritability and any physical discomfort. Heading to the movies to sit in a cool dark theater can be a perfect remedy or take a dip in a natural lake or nearby swimming pool. Air conditioning can be a good option as well, but for those that are sensitive to noise, you will need to balance the benefits of being cool with the disruptive drone from the air conditioner. 

If the season of summer is not refreshing and replenishing for you, please know you are not alone. Focus on activities you enjoy during the summer and give yourself plenty of time for rest. Carve out space in your life and clear your calendar, so you can begin to naturally counteract the stimulus and triggers that overwhelm your nervous system. Continue to commit to simple acts of self care, so you can find relief from the sweltering summer moments. 

REFERENCES
Seasonal Affective Disorder by Mayo Clinic

5 Signs You Have The ‘Summer Blues’ by health enews Staff

Summertime Blues Really Are a Thing by UCI Health

Summertime Sadness: 11 Ways to Chase Away the Warm-Weather Blues 
By Michell Pugle and Medically Reviewed by Alison Young, MD

Summertime Sadness by Tala Ciatti

Being a Highly Sensitive Person Is a Scientific Personality Trait. Here’s What It Feels Like  by Juli Fraga

Authored by Olivia Beisler

Authored by Dr. Brittany Stamer

Let’s discuss how hormonal contraception works to prevent pregnancy. Normally, the two dominant sex hormones that are produced during a menstrual cycle are estrogen and progesterone. They are mostly produced by the ovaries, but also in smaller amounts by the adrenal glands and adipose tissue. These hormones ebb and flow throughout a cycle in order to mature a follicle and eventually ovulate.
​
Hormonal contraception such as birth control pills, hormonal IUDs (Mirena, Skyla, Kyleena, Liletta), implants, or the shot contain synthetic forms of progesterone and/or estrogen. Some types or brands of birth control will contain only synthetic progesterone while some will contain both synthetic progesterone and estrogen. Due to the route of administration and variations of hormones these types of hormonal contraception can each work a little differently, but the basics are similar. These synthetic versions of sex hormones do not act in the body the same way natural hormones do and because the body is receiving a synthetic form of these hormones it does not receive the signal to create it’s own estrogen and progesterone. Meaning hormonal contraception completely shuts down these entire hormonal pathways.

One of the most crucial ways hormonal contraception works is that it impedes ovulation from occurring. In a normal physiological state in relation to ovulation, the brain secretes hormones which then communicate to tell the ovaries to make estrogen and progesterone allowing people of reproductive age to ovulate and become pregnant if desired. When on birth control this entire communication between the brain and ovaries is non-existent. The body “thinks” it has natural estrogen and progesterone based on the synthetic hormones that are being consumed. This communication disruption does not allow ovulation to occur because the ovaries are now not receiving the signal to produce the hormones needed to develop and release a follicle. 

This lack of ovulation means that the bleed that occurs on oral birth control is not technically a menses. For a monthly bleed to be considered a menses there needs to be a flux of natural hormones and ovulation must have occurred. The bleed on oral birth control instead happens due to the withdrawal of synthetic hormones while taking the placebo/sugar pills. 

This lack of natural estrogen and progesterone also prevents pregnancy in many other ways besides inhibiting ovulation. 

Birth control also prevents pregnancy by making cervical fluid inhospitable to sperm. Cervical fluid is necessary to become pregnant. Fertile cervical fluid which looks watery or similar to egg-white occurs immediately before ovulation. It creates a safe haven for sperm to wait until ovulation occurs, creates a sperm ‘highway’ to help the sperm travel quicker and farther into the uterus, has nutrients to feed the sperm, protects and harbors them against the more acidic vaginal pH, and filters abnormal sperm out. Normally, estrogen would signal to the cervix to make this cervical fluid, but because hormonal contraception does not allow the natural influence of estrogen to occur cervical fluid becomes thicker and less functional therefore preventing pregnancy. 

While on birth control the endometrial/uterine lining of the uterus also becomes thinner. This is due to the minimal influence of natural estrogen and progesterone. As an analogy, estrogen will normally act as the bricks and progesterone acts as the mortar of the uterine lining thickening the lining throughout the course of the menstrual cycle. Without these natural influences the uterine lining is much thinner and this makes it very difficult for an embryo to implant and develop there. 

IUDs can prevent pregnancy in the previous ways mentioned, but in addition can create local inflammation in the uterus as well. This prevents pregnancy by making the uterus an inhospitable place for sperm and for fertilized eggs to implant. 

Hormonal contraception can also prevent pregnancy by lowering libido for some users, although this is not true for all. 

All of these reasons are why hormonal contraception is so effective! It works in multiple ways to prevent pregnancy. Most forms of hormonal contraception are above 99% effective with perfect use! 

Yet, for some this high level of effectiveness does not come without side effects. 

Hormonal contraception has been shown to decrease libido by lowering testosterone as previously mentioned. It also can decrease the size of the clitoris. It has been studied to decrease vitamins and minerals possibly contributing to mood changes. One study even revealed that 51% of women experienced a negative mood altering effect from hormonal contraception. It has been shown to cause a slight increase in breast, cervical, and liver cancer as well. The International Agency for Research on Caner (IARC) classifies combined oral contraceptives as a group one (I) carcinogen. It can also negatively affect gut health and thyroid function. While taking oral birth control a protein called sex hormone-binding globulin (SHBG) increases in the body. It is normally responsible for binding to sex hormones in the blood and renders sex hormones inactive while attached. If this SHBG is too high it can keep too large of an amount of sex hormones inactive which can cause significant hormonal dysfunction. SHBG can stay elevated for years after discontinuation.  

Also, another important side effect or result not often discussed is how hormonal contraception can be used as a ‘fix’ for issues like painful periods, endometriosis, fibroids, PCOS, or similar. But, often these conditions are not properly addressed and root causes are not treated before hormonal contraception is initiated. The first time some of these issues are addressed are when patients discontinue birth control and desire to become pregnant. I often see that because these hormonal imbalances had been masked for so long it can take a lot of time and effort to resolve, and this can be difficult when patients want to become pregnant right away. So, while hormonal birth control is a wonderful effective and widely accessible tool to help people plan their futures by preventing pregnancy, which is by far the biggest and best benefit, it absolutely does not cure hormonal issues. Hormonal contraception can actually hide hormonal issues, and the process that may be leading to these imbalances will likely go unaddressed for years until hormonal birth control is discontinued.
To learn more about what contraception choices are best for you and your life I recommend going to www.bedside.org/birth-control.com to explore hormonal and non-hormonal options. 

References 

1. “The Fifth Vital Sign” by Lisa Hendrickson-Jack
2. Bedsider.org 

Authored by Dr. Brittany Stamer

Ovulation is vital to the health of menstruating women. Ovulation is the only way women make a significant amount of progesterone. Progesterone is the hormone responsible for creating the relaxed feeling in the second half of the menstrual cycle, can promote better quality sleep, it can protect against certain cancers, and can reduce PMS or PMDD symptoms. It is also absolutely necessary to become pregnant and to maintain a pregnancy. 

But, it is not a given that every woman between the ages of menarche and menopause are ovulating. There are many reasons ovulation isn’t occurring and these reasons are worth discussing considering it is so important for overall health.  

A very normal reason ovulation may not be occurring is the time around menarche which the first menses. The average age of menarche is 11.9 years. What a time! I remember my mom brought me flowers and gave me a big hug, which basically led me to feel unbelievably mortified. In my older years I grew to appreciate my menses and my mom’s sweetness, but many women can relate to the initial shock I am sure! I digress. Menarche is a very normal time to not ovulate. You might have heard about young women having irregular cycles for a few cycles before them regulating. This could mean the body is not ovulating and is very common. When cycles start for the first time it can take the body some time to get into the rhythm of how the brain communicates with the ovaries. This should normalize within a few months, but if it doesn’t or any significant symptoms such as acne, cramps, mood issues, or otherwise come up it is a great idea to seek support from a holistic practitioner.

Another very normal reason ovulation does not take place is in perimenopause which means the time before menopause. The average age of menopause is 51 years old. As fertility normally decreases ovulation occurs less often as well. 

There are many other reasons that lead to lack of ovulation that should be addressed and treated. Some of the most common reasons are polycystic ovarian syndrome (PCOS), hypothalamic amenorrhea, thyroid disorders, primary ovarian insufficiency (POI), or hypothalamic or pituitary signaling issues. 

PCOS is one of the most common reasons for lack of ovulation, otherwise known as anovulation. There are many causes of PCOS but no matter the cause the underlying mechanism that leads to anovulation is the same. There are too high of androgens or male type hormones in the blood that interfere with the delicate hormone signaling between the brain and ovaries and ovulation cannot occur. Instead, multiple cysts develop on the ovaries revealing an attempt of the ovary to ovulate, but the inability to. PCOS has 4 main causes which include blood sugar dysregulation and insulin resistance, stress or adrenal PCOS as it is sometimes called, inflammatory PCOS which can occur from a host of issues including disrupted gut health or hidden infections, or post-birth control PCOS. 

Hypothalamic amenorrhea occurs when the body simply does not have enough energy to expend to ovulate. The communication from the brain to the ovaries is simply not occurring. This is due to overexercising, under-eating, or excessive stress. 

Thyroid disorders including both hypothyroidism and hyperthyroidism, can both lead to anovulation and can cause either shortened cycles or lengthened cycles respectively. 

Primary ovarian insufficiency (POI) occurs when a woman is headed towards menopause before 40 years old. This can occur due to genetics, radiation, endocrine issues, lack of blood supply to the ovaries, autoimmune conditions, infections, or environmental toxin exposures (heavy metals or mold). This can be slowed or reversed in some cases depending on the cause, if the assaulting factors are removed. 

Pituitary or hypothalamic signaling issues are another issue that can cause anovulation. The most common occurrence in this cause is actually when a woman is breastfeeding! Which is a very normal reason to not ovulate. To breastfeed, the pituitary releases a hormone called prolactin to stimulate the making of breast milk. When prolactin is high it suppresses the body’s ability to ovulate. This can also happen pathologically with something like a tumor in the pituitary which is called a prolactinoma. Prolactin is a common lab test completed when a woman, who is not breastfeeding, is not having a period. This is completed to ensure this more serious cause of anovulation is not part of the picture. 

Having what seems to be a normal and regular cycle does not mean that ovulation is occurring. Most of the time ovulation is occurring in these instances, but not always. There are multiple ways to evaluate if you are ovulating. Cycle charting by tracking cervical mucous and basal body temperature is my favorite way as it connects women to their bodies and allows them to be in tune with themselves. But, completing a blood draw for progesterone post-ovulation in the second half of your cycle can also confirm ovulation. Any value of progesterone above 5 ng/mL means ovulation occurred. 

As I have mentioned in my previous blog post “What is Ovulation Anyway?" a follicle undergoes its most robust development 120 days before being released. This means it can take a significant amount of time for hormones to change enough for ovulation to occur. When trying to correct some of the imbalances that lead to anovulation like PCOS or hypothalamic amenorrhea, patience can be difficult! Especially when it comes to possibly imbalanced hormones and the symptoms people can be experiencing, but these symptoms can improve, these conditions can be treated, and ovulation can happen. 

Even if ovulation is happening, having good egg quality is essential for becoming pregnant and maintaining a pregnancy. Good egg quality is a hard thing to measure unless the eggs are retrieved, as they are in in-vitro fertilization (IVF), and genetically analyzed. But, the level of progesterone in the body post-ovulation can give us a hint about egg quality. Usually higher progesterone means better egg quality. This can mean chances are higher for people to become pregnant.  

You can support ovulation and egg quality/adequate progesterone in many ways. Some of these recommendations can be different based upon what cause of lack of ovulation someone is prone to. But, some basic ways to support healthy ovulation include:

• Eat a well-balanced omnivore diet. I recommend a diet with at least some animal products as they are very nutrient dense, have a lot of protein, and fat. 
• Keep your blood sugar balanced. Eat protein and fat with every meal. 
• Don’t restrict calories. 
• Exercise regularly, but not too much. Overexercise is perceived as a stress on the body. I was a college athlete and had some friends lose their period temporarily from our exercise regimes. 
• Reduce stress. You can do this with anything you like including having fun with friends, laughing, doing a creative project you like, going to therapy, watching TV, reading, yoga, exercise, quitting something that isn’t serving you or your health, and many more things! 
• Sleep! I recommend at least 8 hours of sleep per night. 
• Reduce inflammation. This can mean SO many things. I recommend eating a healthful organic diet, exercising, laughing with loved ones, and reducing stress as the basics. Sometimes this is when testing can help identify the causes of inflammation as they can be hidden like with environmental toxins, heavy metals, mold, hidden infections, or gut health issues. 
• Avoid environmental toxins. Many of these environmental toxins act as synthetic hormones in the body. Avoiding most plastics in the house, getting rid of any products with fragrance, and using a water filter are all good places to start when trying to avoid these toxins. 

References 

1. “The Fifth Vital Sign” by Lisa Hendrickson-Jack 
2. "Trends and Patterns in Menarche in the United States: 1995 through 2013–2017” by National Health Statistics Reports. 
3. "Menopause" by the Mayo Clinic.