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Acne: Acknowledging Frustration & Finding Solutions

5/15/2023

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Authored by Dr. Aidanne
Picture
Photo by Ron Lach on pexels
It is likely that you have experienced acne at some point in your life, as it is one of the most common skin conditions. Of those aged 12-24, it is estimated that 8 in 10 people will experience acne and anywhere from 7-35% of those over the age of 30. This is significant! It is an important condition to address as acne not only affects the skin but can have a detrimental impact on one’s sense of self, self esteem, and social relationships leading to a higher risk of anxiety and depression.


Fortunately, naturopathic doctors are equipped with resources to support your root cause of acne. Let’s dive in!
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.
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Naturopathic Approaches to PCOS

5/4/2023

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Authored by Dr. Barrett
Picture of uterus and ovaries from Pexels
Photo by Nadezhda Moryak
Polycystic Ovary Syndrome (PCOS) impacts between 5-10% of people with ovaries. The word ‘syndrome’ is important. A disease generally has a known cause, clear symptoms and accepted treatments. A syndrome however is a collection of signs and symptoms that tend to appear together. Syndromes generally don’t have an understood cause. This is true of PCOS. Over the years the diagnostic criteria has shifted and we still don’t have a very clear way to diagnose PCOS. 

In general the signs and symptoms of PCOS may include:

  • Irregular periods
  • Growing thick, dark hair on the upper lip, chin, chest, or belly
  • Hair loss on the head
  • Acne
  • Polycystic ovaries on ultrasound
  • Elevated androgens (type of hormone) in the blood
  • Weight gain 

Some people with PCOS just have irregular cycles or absent/delayed ovulation. It is most common to have irregular periods, signs of elevated androgens (acne and facial hair growth), and cysts on the ovaries. 

PCOS can increase your risk of other health concerns including: (1)

  • Diabetes (high blood sugar)
  • High cholesterol levels
  • Infertility
  • Sleep apnea
  • Depression or anxiety
  • Eating disorders (2)
  • Losing interest in sex

The typical treatment for PCOS is birth control pills. These don’t cure the condition but they can control some of the symptoms such as irregular periods, acne and excessive facial hair growth. Other medication options include medications for managing blood sugar and medications that lower androgens. 

There are several blood tests to consider if you have or think you may have PCOS: 

  • Fasting glucose and insulin
  • HbA1c 
  • LH and FSH prior to ovulation
  • AMH (Anti-Mullerian Hormone) 
  • Androgens including free and total testosterone, DHEA-S and androstenedione
  • SHBG

In naturopathic medicine we take several approaches to treating PCOS including:

  • Addressing insulin resistance and blood sugar regulation 
  • Reducing inflammation that perpetuates insulin resistance and elevated androgens
  • Supporting the hypothalamus-pituitary-adrenal (HPA) axis. Androgens are derived from both the ovaries and the adrenals so supporting these glands is important. 
  • Using nutrients and herbs to lower androgen levels, support ovarian health, and reduce insulin sensitivity
  • Assessing and supporting thyroid and gut health

A small snapshot of what could be included on a treatment plan:  
​


  • Lowering the carbohydrate content in the diet and focusing on fat and protein intake. 
  • Increasing vegetable and fiber intake
  • Adding physical activity
  • Managing the stress response to take strain off the HPA axis 
  • Using nutrients and herbs such as:
    • Inositol
    • Spearmint tea
    • Licorice
    • NAC

Naturopathic medicine has many tools to help manage PCOS. It’s important to note that PCOS is a lifelong syndrome. We are all programmed metabolically so the lifestyle changes to improve symptoms and prevent the possible outcomes mentioned above need to be lifelong. 


References:
  1. Robert L Barbieri, MDDavid A Ehrmann, MD UptoDate “"Patient education: Polycystic ovary syndrome (PCOS) (Beyond the Basics)"
  2. Bernadett M, Szemán-N A. [Prevalence of eating disorders among women with polycystic ovary syndrome]. Psychiatr Hung. 2016;31(2):136-45.

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Endometriosis: A Naturopathic Approach To Relief

4/20/2023

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Authored by Dr. Aidanne
PicturePhoto from cottonbro studio on Pexels
Typically, endometrial tissue is only found in the uterus. In the case of those living with endometriosis this tissue can be found in other areas of the body such as the pelvis, chest, and abdomen. Endometriosis affects 1 in every 10 women of reproductive age and although it is non-malignant, the root cause is not well understood. There are multiple theories as to why it may occur but ultimately, we don’t have a clear answer or cure.

​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 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.
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Naturopathic Approaches to PMS

4/6/2023

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Authored by Dr. Barrett
Picture
Nataliya Vaitkevich on Pexels
PMS stands for Premenstrual Syndrome. It refers to a set of physical and emotional symptoms that over 75% of people experience leading up to their menstrual period. (1) The severity of PMS symptoms varies from person to person. During the menstrual cycle the levels of estrogen and progesterone rise and fall. In the days leading up to menstruation, the levels of estrogen and progesterone drop. Serotonin, our happy neurotransmitter, is also impacted by these hormone fluctuations. 

According to the Mayo Clinic the symptoms of PMS include: (2)

Emotional and behavioral signs and symptoms
  • Tension or anxiety
  • Depressed mood
  • Crying spells
  • Mood swings and irritability or anger
  • Appetite changes and food cravings
  • Trouble falling asleep (insomnia)
  • Social withdrawal
  • Poor concentration
  • Change in libido

Physical signs and symptoms
  • Joint or muscle pain
  • Headache
  • Fatigue
  • Weight gain related to fluid retention
  • Abdominal bloating
  • Breast tenderness
  • Acne flare-ups
  • Constipation or diarrhea
  • Alcohol intolerance

As always we want to look into the root cause behind symptoms and some possible causes of PMS include:
  • Imbalances in estrogen and progesterone
  • Fluid and electrolyte abnormalities
  • HPA (hypothalamus-pituitary-adrenal) axis dysregulation which is a fancy way of saying an imbalance stress response. 
  • Neurotransmitter dysfunction
  • Nutrient deficiencies
  • Digestive/microbiome health imbalances. The digestive component can be overlooked and it’s an important one. We excrete estrogen through the digestive tract and if our microbiome is imbalanced we can reabsorb estrogen burdening our body with a hormone it’s already tried to get rid of. 

PMS can be broken down into subtypes but it’s important to note that many people experience symptoms across the subtypes. 

PMS-A (anxiety): This subtype is characterized by symptoms such as anxiety, tension, irritability, mood swings and insomnia. PMS-A is typically caused by low progesterone and elevated estrogen. 

PMS-C (cravings): This subtype is characterized by symptoms such as food cravings, especially for sweet or salty foods. They can also experience headaches, palpitations, fatigue and dizziness. PMS-C is typically caused by low magnesium and elevated PGE1. 

PMS-D (depression): This subtype is characterized by symptoms such as depression, fatigue, forgetfulness, insomnia and a lack of energy. PMS-D is typically caused by elevated progesterone and low estrogen. 

PMS-H (hydration): This subtype is characterized by symptoms such as bloating, water retention, and breast tenderness. PMS-H is typically caused by an increase in sodium retention and increases the hormone aldosterone. 

How to support your body to treat or prevent PMS

Exercise Regularly
The research is clear, people who exercise regularly do not have PMS symptoms as often as people who don’t. Even 8 weeks of regular aerobic exercise showed improvement in physical and psychological symptoms. 3

Manage Stress Levels
Stress puts strain on our adrenal glands which can lead to fluctuations in cortisol output. These fluctuations can cause a blood sugar roller coaster. It’s also important to note that the hormone aldosterone that impacts our fluid retention is also produced in the adrenal glands. One of the best ways to manage stress? Exercise!

Maintain Healthy Eating Habits
  • Keep your blood sugar balanced by eating protein with each meal or snack and limiting refined/processed carbohydrates. 
  • Cut out caffeine.
  • Reduce or cut out alcohol.
  • Increase your fiber intake to at least 35g per day.
    • 2 TBS of ground flaxseed is particularly helpful.

Supplements to Consider
  • Magnesium glycinate: Magnesium helps relieve stress, anxiety and water retention. A standard dose for PMS is 400-600mg daily. (4)
  • B6: many studies show a positive effect with B6 supplementation for PMS symptoms. A standard dose is 40-100mg daily. Do not take over 200mg daily for long periods of time as it can lead to neuropathy.
  • Multivitamin: a 2020 study looked at using B6 alone vs B6 along with a multivitamin and the combination of B6 and a multivitamin achieved remission of PMS symptoms for 72% of the participants (5)

Botanical Medicine
There are several herbs that can help support a healthy menstrual cycle. Talk to your naturopathic doctor about which herbs may be right for you. 

Testing
The information above is simplified and some patients may benefit from hormonal testing to get the full picture and properly treat their symptoms. We utilize both functional testing, such as the DUTCH test, and conventional blood work to assess our patients. 


References:
  1. Kues JN, Janda C, Kleinstäuber M, Weise C. How to measure the impact of premenstrual symptoms? Development and validation of the German PMS-Impact Questionnaire. Women Health. 2016 Oct;56(7):807-26. doi: 10.1080/03630242.2015.1118734. Epub 2015 Dec 1. PMID: 26624615.
  2. https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/symptoms-causes/syc-20376780 
  3. Samadi Z, Taghian F, Valiani M. The effects of 8 weeks of regular aerobic exercise on the symptoms of premenstrual syndrome in non-athlete girls. Iran J Nurs Midwifery Res. 2013 Jan;18(1):14-9. PMID: 23983722; PMCID: PMC3748549.
  4. Walker AF, De Souza MC, Vickers MF, Abeyasekera S, Collins ML, Trinca LA. Magnesium supplementation alleviates premenstrual symptoms of fluid retention. J Womens Health. 1998 Nov;7(9):1157-65. doi: 10.1089/jwh.1998.7.1157. PMID: 9861593.
  5. Retallick-Brown H, Blampied N, Rucklidge JJ. A Pilot Randomized Treatment-Controlled Trial Comparing Vitamin B6 with Broad-Spectrum Micronutrients for Premenstrual Syndrome. J Altern Complement Med. 2020 Feb;26(2):88-97. doi: 10.1089/acm.2019.0305. Epub 2020 Jan 10. PMID: 31928364
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