If you’ve been suffering from irritable bowel syndrome (IBS) and want to get to the bottom of your symptoms, there are some crucial tests that you may want to consider running through your naturopathic doctor. You’ve probably tried many different things already to help with your symptoms through trial and error, without significant or lasting relief. Testing eliminates much of the guesswork and helps us target our treatment so that you can get better faster!
During your initial visit with me, your medical history will give us a clue to what might be causing your symptoms. It could be one of the ones outlined in my previous blog. I’m giving you a list of the most common tests to consider, but most people only need to invest in one or two of these tests. By far, the most common test that I run with IBS patients is the first one, IgG Food Sensitivity Testing.
1) IgG Food Sensitivity Testing
This is a blood test that measures levels of IgG antibodies to 120-200 foods, depending on which panel we run. It allows us to identify objectively which foods are the most likely to be causing the most inflammation in your digestive system. If we run this test, you will receive a printout of which foods you reacted to highly, moderately, or not at all. If you end up having a large number of reactive foods, you most likely have a condition called leaky gut, where the intestinal barrier becomes excessively permeable, leading to reactions to many foods. Repairing that leaky gut through naturopathic treatments can often allow you to eventually bring more foods back into your diet.
2) Candida IgG Test
This is also a blood test, and can be added on to the IgG Food Sensitivity Test, or run on its own. It would be run if we suspect a yeast or Candida overgrowth which could contribute to IBS-like symptoms. If your results turn out positive, then we would treat the overgrowth with dietary changes and targeted supplements.
3) SIBO Breath Test
Unlike the two tests above, this test is a breath test. You are given a lactulose solution to drink, and at timed intervals, take breath samples in the comfort of your home. The lactulose feeds bacteria in your intestine, and they will then produce hydrogen and/or methane gases as they break the lactulose down. These are the gases that are measured in your breath. If unusually high levels of those gases are found in your samples, you probably have Small Intestinal Bacterial Overgrowth (SIBO), a common cause of IBS. There is a multi-step process to treat SIBO, but the good news is that it CAN be treated!
4) Comprehensive Stool Analysis (+/- Parasitology)
This test requires a stool sample, usually taken from 3 different bowel movements. It gives a comprehensive assessment of your digestive health, including which bacteria (beneficial and harmful) are present and their relative amounts, any yeast overgrowth, parasites, and other information on how well your digestive system is working. If we suspect parasites, this would be the test to run, but it can also be run if we suspect an imbalance in the beneficial bacteria in your digestive system, or if your digestive system is a mess.
If you’ve been suffering from IBS symptoms for a while, testing could be a lifesaver, preventing you years of trial and error with different supplements and medications!
Ready to start feeling better now? Book your initial visit with me today, and we’ll start investigating so that you can get to the bottom of your IBS.
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In my last blog, I shared with you some background information about what a diagnosis of irritable bowel syndrome, or IBS, means. The symptoms and diagnosis are just the tip of the iceberg. The bottom line is, if you’ve been diagnosed with IBS, you will want to dig deeper in order to find out what is causing your symptoms, and modify the factors you CAN control in order to get your symptoms under control.
I’ve had countless patients go from having daily diarrhea and bloating to having happy bowels that no longer cause them daily anxiety and stress, once we find and treat the cause! This is a very personalized process, as what causes IBS for one person doesn’t necessarily cause it for another. Additionally, many times there is not just one cause, but a combination of factors that must be addressed.
When a patient comes in to see me with IBS, I have a running list of possible causes going through my mind, trying to fit the pieces of the puzzle together for that person as I listen to their particular story. Here are the top 5 causes of IBS that I consider. This list is by no means exhaustive! Working with a naturopathic doctor and ordering the appropriate testing will help you get long-lasting relief for your symptoms!
1) Food Sensitivities
Many patients’ IBS symptoms resolve or significantly improve after we identify specific problematic foods, either through IgG food sensitivity testing, or through an elimination diet. Food sensitivities can cause IBS symptoms since they increase inflammation in the gut and irritate the gut lining. It can be difficult to identify your food sensitivities just by keeping a diet diary, since you can notice digestive symptoms from a food up to 72hrs after eating it! The most common problematic foods tend to be gluten, dairy, eggs, corn, and soy.
2) Small Intestinal Bacterial Overgrowth (SIBO)
Bacteria can overgrow in the small intestine, as a result of many things, including lots of antibiotics, low stomach acid, and a dysfunction in the movement of muscles surrounding the intestines. It’s actually a very common cause of IBS, being present in from 35-80% of IBS cases! If your IBS symptoms come with lots of bloating, you’ve been on strong antibiotics or antacids, and probiotics make you feel worse, it might be a good idea to get tested for SIBO.
3) Lactose Intolerance
Many people figure this one out by trial and error, as drinking a glass of milk makes them run to the washroom within half an hour. However, many people go undiagnosed for years, as the symptoms can be just shrugged off as IBS. There is a test available for this as well, if you’re unsure.
4) Yeast Overgrowth
Just like bacteria can overgrow in the digestive system, so can yeast! Candida albicans is a yeast that is commonly found in the digestive tract in small amounts, but if the opportunity arises, it can overgrow and cause a variety of symptoms that can fall under the umbrella of IBS. The most typical triggers for Candida overgrowth are chronic antibiotic use and/or a diet high in sugar, but there are others, including chronic stress and the use of the birth control pill. If you’re a woman and have IBS symptoms along with frequent vaginal yeast infections, getting tested for Candida overgrowth would be an important step to find out if it’s causing your IBS symptoms.
5) FODMAPs Intolerance
FODMAPs foods are made up certain types of sugars and short chain carbohydrates that can be difficult to digest. The acronym stands for Fermentable-Oligosaccharide-Disaccharide-Monosaccharide-And-Polyols. Unlike food sensitivities that are due to a reaction to the protein portion of a food, in this case, you may be unable to break down and digest the carbohydrate portion of certain foods. Avoiding high FODMAPs foods has been shown to improve IBS symptoms. Sometimes, however, patients cannot tolerate these foods because they already have an overgrowth of certain bacteria or yeast which thrive on these foods and ferment them to create more gas! See how different causes can be related?
There are many other factors which cause or aggravate IBS, including chronic stress, low stomach acid, chronic use of certain analgesics, and a dysfunction in the action of the muscles surrounding your digestive tract (the migrating motor complex).
Do you want to get to the bottom of your IBS symptoms? In the next blog, I’ll be discussing in more detail about what crucial tests you should consider if you’ve been diagnosed with IBS.
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Atkinson, W., Sheldon, T.A., Shaath, N., and P.J. Whorwell. (2003). Food elimination based on IgG antibodies in irritable bowel syndrome: A randomized controlled trial. Gut, 53:1459–1464. http://gut.bmj.com/content/53/10/1459.full.pdf
Dainese R1, Casellas F, Mariné-Barjoan E, Vivinus-Nébot M, Schneider SM, Hébuterne X, Piche T. (2014). Perception of lactose intolerance in irritable bowel syndrome patients. Eur J Gastroenterol Hepatol., 2014 Oct;26(10):1167-7. https://www.ncbi.nlm.nih.gov/pubmed/25089542
Halmos EP1, Power VA2, Shepherd SJ2, Gibson PR3, Muir JG3.(2014). A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology, 2014 Jan;146(1):67-75.e5. https://www.ncbi.nlm.nih.gov/pubmed/24076059
Mann, N.S., and Limoges-Gonzales, M. (2009). The prevalence of small intestinal bacterial overgrowth in irritable bowel syndrome. Hepatogastroenterology, 2009 May-Jun;56(91-92):718-21. https://www.ncbi.nlm.nih.gov/pubmed/19621689
You plan your trips based on the nearest washroom. You’ve limited what you eat because you’re constantly feeling bloated, gassy, or your tummy aches. You have diarrhea or constipation, or both! Your energy is down the drain from constantly dealing with your digestive issues. If you’re a woman, you may notice worse symptoms around the time of your period. You might be anxious or depressed because this is taking such a toll on you and nothing you do seems to work. You’ve limited your social life because you don’t feel energetic or you can’t eat out without feeling horrible afterwards... If you have IBS (irritable bowel syndrome), then you can probably relate!
If you’re at your wits’ end and you’re about to give up, don’t! There’s a lot we can do to help you feel better! And, contrary to what you may have been told, it’s not all in your head.
Irritable bowel syndrome – it sounds harmless enough, but for those that deal with it on a daily basis, it has a serious impact on their quality of life. So many people have it (2.1-22% of the population, that’s almost a ¼ of the population!), yet most people have no clue what they can do about it and think they just have to “live with it”. It’s one of the most common conditions that I treat in my Nepean and Orleans practices. You may have been diagnosed with IBS, or you may be struggling with chronic digestive issues and be one of the 75% of people that goes undiagnosed. If you’re a woman, you’re 1.5-2x more likely to have it!
While a diagnosis is helpful to give your digestive troubles a name, unfortunately it doesn’t give your healthcare professionals a clear-cut answer to treating it. Why? Because a diagnosis of IBS doesn’t tell you anything about what’s actually causing it!
You might have chronic digestive issues, but you haven’t been diagnosed with IBS by your doctor. Could you still have IBS? Yes you could! IBS describes a group of symptoms commonly found together that are going on for a period of time, at least 3 months to be exact.
If you have these symptoms, you likely have IBS (Rome III criteria):
-For at least the past 3 months, you have had recurrent abdominal pain (it is often described as discomfort, not necessarily pain)
-These abdominal symptoms have to be present at least 3 days a week during the past 3 months
-These abdominal symptoms have to be accompanied by at least 2 of these 3 criteria:
That means that, if you’ve gotten a diagnosis through your medical doctor, your doctor has probably ruled out more serious conditions, such as Celiac disease, Crohn’s disease, ulcerative colitis, or colon cancer. You may have had a scope done to have a closer look at your bowels (likely a colonoscopy and possibly an endoscopy), but nothing abnormal could be found, except perhaps some spasticity in the muscles surrounding the digestive tract. You can breathe a sigh of relief that these more serious conditions are not likely playing a role in your symptoms. But that doesn’t change the fact that your symptoms are still with you!
So, what a diagnosis of IBS tells you is that you have to dig deeper to find out what’s causing it if you want to get better for good. The good news is that I can help you with that! In the next few blogs, I’ll be discussing what the possible causes of IBS are, common testing that I run with patients to guide their treatment, and things you can start doing to feel better.
If you want to start feeling better now, make sure to book an initial visit here with me. As I mentioned earlier, helping patients with IBS is a huge part of my Ottawa practice, and it would be a privilege to help you too!
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Yoon, S.L., Grundmann, O, Koepp, L, and Farrell, L. (2011). Management of irritable bowel syndrome (IBS) in adults: conventional and complementary/alternative approaches. Altern Med Rev, 2011 Jun; 16(2): 134-51. https://www.ncbi.nlm.nih.gov/pubmed/21649455
I love spending time in nature, so taking walks and hikes in the Ottawa outdoors comes easily to me. Running? Not so much. But this summer and fall, I chose to learn to run. Why did I choose running? It was an activity I could commit to on my own that would get me outdoors, many of my patients loved it, it was a quick way to feel energized, and it looked easy...
As easy as it looked with all of the spandex-clad professional runners in my neighbourhood gliding by effortlessly, I soon discovered that running takes a lot more work and perseverance than I’d imagined. Like any new skill, it takes time to learn and ingrain into your daily schedule before it becomes almost second nature. I’d tried running in the past, but never seemed to be able to push through the barrier of feeling that exhilarating rush of endorphins rewarding me. I only knew to expect the stretch of lungs nearly exploding or a painful side stitch after only a few minutes in. But this summer was different. This summer, I had a goal. I was going to run a 5K. Seems easy, right?
I had bought myself a new pair of runners last year (after an assessment with Dr. Steve Pelletier, a colleague and chiropractor at my In Balance clinic), so I already had the best pair of shoes I had ever owned, only lightly used since last year. I was inspired by patients who were running in the Ottawa Race Weekend in May. And, I had just gotten a new phone in June, which propelled me into the “new” world of app technology, and downloaded one of my first apps, the Couch Potato to 5K app. This app was a lifesaver for me, as it broke my 5K goal into small, manageable steps of 3 workouts a week for 8 weeks.
So off I went on my first day. I passed by seasoned runners and felt like a fake when I zoomed by someone during my 1min running spurts (only to turn the corner and go back to walking), but at least I was running! The first few weeks were easy enough. I was alternating between walking and running, slowly increasing the length and frequency of the runs. When I felt like giving up, I would encourage myself to keep running until the lady on the app chimed in that it was time to walk again. The app was great for keeping me accountable and for pacing me so that I wouldn’t try to do too much too fast!
By the end of the second week, I was already starting to feel good after my runs. I could feel my lung capacity expanding, my confidence growing, and felt energized after my runs (not exhausted like I had after my previous attempts years ago)! And that was after only a total of 9 minutes of running! My goal was to run non-stop for 35 minutes.
By week 5, I was running at least 6 minutes straight, and enjoying it! I was proudly telling my friends and colleagues that I was running a total of 16 minutes. However, I had a setback during my two weeks of vacation, when I fell out of my usual routine and didn’t make time for running. Following that, I had a few busy weeks where I kept running on the back burner... Since I had told so many people about my running goal, however, they started to ask me how my running was going. Those promptings helped me to pick up my running shoes once again and hit the pavement. I was a little apprehensive about hitting the road again after a few weeks, as I didn’t know if I’d have to go backwards in my running regimen. I was surprised that all I had to do was repeat one workout before I felt good enough to continue right where I had left off!
The last few weeks were tough, I admit, especially when moving from 10 minute running intervals with a 5 minute walking break, to 20 minutes of running non-stop. But once I hit the 20 minute mark, continuing to run a bit longer was not as big of a mountain as it once seemed! I hit my 35 minute running goal on October 5th, and was so proud of myself! And today, I finally hit my 5K non-stop running goal, with my best pace so far!
I’m definitely not done running, but I wanted to share some of the things that I learned about forming new healthy habits through my running experience so far. This doesn’t only apply to running! It can apply to any health goal or new habit that you want to form for yourself.
1) Break your big goal into small, bite-sized, micro-goals
Sure, it’s great to have a big goal and to dream big. But it’s the day-to-day effort, in which you may not see much progress, which gets you there. Every single day, you have to make decisions that will either help move you towards that goal, or away from it. The key, I have found, is to break the goal into so small chunks that you have almost no resistance to swallowing them! Dream big and visualize your end goal, but start small so that you don’t overwhelm yourself. For me, following the app I used helped me to break my effort down into manageable chunks which only required my time 3 days of the week.
2) Identify your obstacles (so that you can come up with solutions to overcome them)
If you can’t keep up with your micro-goals, don’t give up! Keep reassessing and take a minute to analyze what is stopping you from reaching them. Are you going to sleep too late and can no longer get up early for your run? Then work on changing your bedtime routine. Are you developing knee pain? Get assessed with a chiropractor or osteopath to make sure that you are running correctly and do the proper strengthening exercises (I had this happen and got some great advice from Dr. Pelletier). You may need to adjust your micro-goals to be more realistic, or remove other non-essential habits that are taking your time from your daily routine. Perhaps you need to change the negative soundtrack in your head that is telling you that you can’t do this or that you will fail. Change is difficult, but the right type of change is worth it! Don’t give up!
3) Have an accountability buddy
Share your goals with friends that will be supportive in helping you reach them. Having an accountability buddy can really help you get out there when you really don’t feel like it. As you head outside, you’ll hear their encouraging cheers fueling you along when your own cheers start to fade. This is also a role that your naturopathic doctor can play in helping you reach your health goals! We help keep you on track so that you can reach your health goals quicker and easier.
4) Attach your new habit to an old one
I often tell my patients who forget to take their Vitamin D drops to keep them next to their toothbrush (one of the brands I recommend is also appropriately peppermint flavoured). That way, each time that they brush their teeth in the morning (an already established habit), they will have the cue they need to remember to take their Vitamin D. In the running example, attach your new habit to an existing one. For example, “after I get up in the morning and before I shower, I will go for a run on Mondays, Wednesdays, and Fridays”. These contextual cues can help you have a built-in reminder to stick to your new habit.
5) Redefine success = effort
It’s easy to give up when there are bumps along the way. In running, I had some days where I had less stamina and had to run much slower. It’s ok to not feel your best every time. You don’t have to do it perfectly every time. Remember why you are doing this (for your health and well-being), and that luckily we don’t have to run like a seasoned athlete to reap the benefits. Savour the process itself. Enjoy that split second you feel like you have wings under your feet lifting you off the ground. Breathe in the fresh air! Celebrate the fact that you have made the effort to go outside. After all, reaching your goal doesn’t happen overnight.It comes from a series of day-to-day efforts. Why not celebrate your efforts, your day-to-day successes?
I hope that these 5 tips will help you to take the first step to build new health habits that stick! As you can see, a big part of the whole battle is a battle of the mind. And it’s not all about willpower either. Remember, make the transition to the new habit so easy that it’s almost impossible to say no.
If you have plans to get healthier but don’t know how to get there or what that would look like for you, I’d be happy to be both your naturopathic doctor and your accountability buddy!
Most women that I see in my Ottawa practice who are in their reproductive years suffer from premenstrual syndrome (PMS) to some extent. Actually, about 75% of women in this demographic experience PMS (Medline Plus, 2016). Does that make it normal? While a low level of discomfort can be expected (after all, there are huge hormonal changes occurring all at once within the week before your period), in many cases, more severe symptoms are pointing to underlying hormone imbalances or deficiencies that should be addressed.
What Is PMS?
PMS is generally defined as a group of symptoms that comes and goes cyclically based on where a woman is in her menstrual cycle. They usually will start in the second half of the cycle (at least 14 days after the start of a period in a woman with a textbook 28 day cycle), and will go away 1-2 days after menstruation starts (Medline Plus, 2016).
Typical PMS symptoms can include one or more of the following:
-Bloating and/or increased gas
-Changes in bowel movements, such as constipation or diarrhea
-Mood changes, such as heightened emotions, irritability, anxiety, or depression
-Skin changes, such as cyclical acne
Paying attention to these sometimes subtle changes can give you a clue about what imbalances you may have.
The 4 Main Types Of PMS
PMS is classified into 4 main types. If you fit primarily into one of these 4 main types, your naturopathic doctor will be able to gain valuable insight just from your symptoms!
1) PMS-A (Anxiety): This type of PMS is characterized by symptoms of increased anxiety, irritability, and emotional lability.
What it means: PMS-A is usually associated with a high estrogen to progesterone ratio. Think of progesterone as the calming hormone between the two. If you don’t have enough of the calming hormone, estrogen will trigger the release of the more stimulating hormones, cortisol and adrenaline, which will make you feel more on edge. As well, if you’re on or have taken birth control pills in the past, you may have excess estrogen in your system, which can worsen these symptoms.
Treatment options: Using natural strategies to increase progesterone (such as the herb Chaste Tree), get rid of excess estrogen, and decrease stress is very helpful for PMS-A sufferers. Increasing magnesium intake can also be helpful. If you have severe PMS-A symptoms, and especially if you are peri-menopausal, you may benefit from cyclical use (post ovulation) of bio-identical progesterone cream (which I can prescribe).
2) PMS-C (Cravings): If you experience strong cravings the week before your period, especially carbohydrate cravings, then you are probably suffering from PMS-C. You may also crave stimulants and chocolate, get heart palpitations, and you may get headaches and energy highs and lows from fluctuating blood sugar levels.
What it means: These symptoms are thought to be due to changes in the way insulin binds. As a response to blood sugar in your bloodstream, your body produces insulin as a signal to bring the sugar into the cells. However, in the days leading up to a period, a woman’s cells become less sensitive to this insulin signal, leading to imbalances in blood sugar regulation. Giving in to sugar cravings can actually make PMS-C symptoms worse, since the body can’t deal with this influx of sugar properly.
Treatment options: Stabilizing blood sugar with a high protein diet low in refined carbohydrates is really important if you suffer from PMS-C. These blood sugar imbalances can also show up as acne in the skin, since high sugar in the blood can lead to more breakouts. Eat small and frequent meals, and avoid alcohol.
3) PMS-D (Depression): If you feel really down before your period, you don’t feel like participating in your regular social activities, you feel grumpy, angry, or have crying spells before your period, you may suffer from PMS-D. If you have pre-existing depression, you might feel like your symptoms are worse leading up to your period. Another feature of this type of PMS is that it may be associated with premenstrual acne.
What it means: The etiology of this type of PMS is like the reverse of PMS-A, with elevated progesterone levels, and low estrogen levels. While progesterone decreases anxiety, too much progesterone relative to estrogen can depress the nervous system, leading to symptoms of depression. As well, the happy neurotransmitter serotonin is decreased when estrogen levels are low, worsening feelings of depression. There also may be elevated testosterone levels, which can lead to increased acne.
Treatment options: Some foods and herbs with phytoestrogenic activity can be used to balance estrogen levels. As well, if you have elevated androgens (hormones such as testosterone and DHT), these can be balanced using natural therapies. Including foods high in tryptophan (the precursor to the feel good hormone, serotonin) can help with mood: sour cherries, turkey, cottage cheese, and oats are all high in tryptophan (Pope, 2016).
4) PMS-H (Hyperhydration): If you routinely gain a few pounds before your period, your abdomen feels swollen, or your breasts get more swollen and tender, you are likely suffering from PMS-H. Rings on your hands may feel tighter if it also affects your extremities.
What it means: The increased extracellular fluid which leads to symptoms of fluid retention is due to higher aldosterone levels. Aldosterone is a hormone produced by the adrenal glands that helps the body retain fluid. This can be compounded with lower dopamine levels typical in the days leading up to the period.
Treatment options: Eating foods high in salt makes the body retain more water, so decreasing your salt intake and processed foods can help decrease the fluid retention. Increasing magnesium intake can also help reduce aldosterone levels and improve symptoms.
What’s A Girl To Do?
If you are tired of dealing monthly with your PMS symptoms, there is a better way than just pushing through it. Prominent PMS symptoms are signs for you to pay attention to the subtle imbalances in your body. The above treatment options will work for some but must be adapted to your particular case. Naturopathic doctors can help you balance your hormones with tools such as liver supporting and hormone balancing herbs, nutritional supplements, dietary changes, and acupuncture. In more complicated cases, we may need to run hormonal testing (blood or salivary) to find out exactly what we’re dealing with.
If you want to get to the bottom of your PMS, I’d love to help. You can get in touch here.
Image from: http://www.123rf.com/profile_rodimovpavel'>rodimovpavel / 123RF Stock Photo
Kaslow JE (2016). Premenstrual Syndromes. Jeremy E. Kaslow, MD. Retrieved from http://www.drkaslow.com/html/premenstrual_syndromes.html.
Pope N (2016). Naturopathic Infertility Treatments Timed With Cycle Charting. Webinar May 15, 2016.
White CD (2016). Premenstrual Syndrome. Medline Plus. Retrieved from https://medlineplus.gov/ency/article/001505.htm.
You may have heard of the term “detox”, but don’t really know what it entails. It may conjure up images of juicing or cayenne pepper cleanses, starvation diets, or even drug and alcohol addiction centres. This is NOT what I’ll be talking about today. I’ll be talking about metabolic detoxification: how you can maximize your own body’s cellular detoxification capabilities so that you can clean up the inside of your body and feel your best!
You probably don’t think twice about cleaning up your outside: you brush your teeth, take a shower, wash your hair, cut your nails, etc. But what about the inside of your body? How does it deal with the onslaught of industrial chemicals, pesticides, hormone disruptors, heavy metals, and other substances that are foreign to it? How does it get rid of internal toxins, such as metabolic waste products, immune reactions to food, free radicals, and fermentation products from unhealthy gut bacteria?
Detoxification – What Is It?
Luckily, our bodies have a built-in detoxification system that helps us get rid of the toxins we are exposed to. We are constantly detoxifying through this mechanism every second of our lives! However, just relying on that and going on your merry way is often not enough. “De-toxification” literally means to remove toxins, and in today’s society, we are exposed to more and more industrial chemicals, plastics, and hormone disruptors than ever before which “clog up” our detoxification mechanisms. A study done in 2009 found that the 10 minority ethnic group babies tested (this was a US study) were born with up to 232 toxic chemicals in their umbilical cord (EWG, 2009)! This number is likely higher than the average Canadian newborn, but showcases just how our toxicity is getting passed on to the next generation.
In wholistic and integrative medicine, detoxification refers to a healing method used to improve physiological function by eliminating existing toxins, avoiding new toxins (as much as possible), and supporting the organs of elimination (primarily the liver, the gut, and the kidneys).
The liver modifies and packages the toxins into forms that can leave the body, either by getting packaged into bile to leave through the gut, or made water soluble to leave through the kidneys. If any main detoxification organ system gets “clogged up”, this puts undue strain on our other primary detox organs, as well as our secondary detox organs (the skin, lymphatic system, and lungs).
Could You Benefit From a Detox?
If you’re living and breathing in our 21st century world, eating out of plastic containers, taking (or have a history of taking) birth control pills and various pharmaceutical drugs long-term, planning to get pregnant, eating primarily non-organic food, or using perfumed products and cosmetics, chances are you’ve accumulated some of these toxins in your system and could benefit from a detox!
Here are some additional symptoms that could be associated with an elevated toxic burden:
-chronic digestive issues
This is not an exhaustive list, since toxins can have various side effects, depending on the nature of the toxins. When shouldn’t you detox? If you’re pregnant, have compromised liver or kidney function, and with some chronic diseases, a detox is likely not the right avenue for you at this time.
What Foods Can Help with Detoxification?
The liver is the primary processing plant in the body for sorting and getting rid of toxins. Most detoxification programs will include foods (and supplements) that help with both Phase 1 (modifying) and Phase 2 (packaging for elimination) detoxification enzymes in the liver. Phase 1 reactions often end up creating a more toxic bi-product, so you want Phase 2 enzymes to be working efficiently to get rid of it. While I won’t go into supplements here, you can start including more of these beneficial foods into your diet today (Hodges, 2015)!
Phase 1 supporting foods: lemons, dark green leafy vegetables, cruciferous vegetables, oranges, tangerines
-Pro tip: If you can’t tolerate much caffeine, you may have slow Phase 1 detox enzymes since they break down caffeine.
Phase 2 supporting foods: cruciferous veggies, legumes, adequate lean protein, turmeric, green tea, raspberries, blueberries
-Pro tip: If you have multiple chemical sensitivities, you may have a buildup of Phase 1 metabolites, either from too quick Phase 1 enzymes, too slow Phase 2 enzymes, or both.
What Does a Typical Detox Program Entail?
We typically can’t avoid our daily exposures to car exhaust, but we do have a tool that we can use daily to reduce our toxin exposure: our fork and what we put at the end of it! A typical detox program will:
-Reduce overall pesticide exposure by emphasizing organic foods
-Eliminate processed foods, sugar, alcohol, and minimize if not eliminate coffee to decrease unnecessary burden on the liver
-Remove known or typical food sensitivities that increase inflammation in the body
-Emphasize organic and nutritious foods that support Phase 1 and Phase 2 detoxification in the liver, as well as include liver-supporting supplements
-Emphasize lots of water and fluids to support kidney detoxification
-Include high fiber foods, probiotics, and gut healing supplements to allow the bowels to eliminate toxins adequately
There are various levels of detoxification. Have you ever started cleaning one area of your house, only to realize that other areas needed cleaning too? Once you’ve mastered the food level, you can look into decreasing toxin exposure from plastics, cosmetics, stress hormones, or other areas, if needed. Regular moderate exercise helps keep the lymphatic system running smoothly, improves overall health, and decreases stress hormones. But there’s no need to overwhelm yourself. Start with one small aspect, and you will already reap the benefits!
What About Detox Reactions?
Have you ever set out to deep clean a room in your house, only to be overwhelmed with the sheer number of items that are uprooted and need to be sorted in the process? A similar thing can happen when you are doing a detox, usually within the first 2-4 days. As your body tries to detoxify, you may feel like you are getting a flu, with body aches or headaches. Not everyone gets these symptoms, but if you do, it usually only lasts a day or two. If it lasts longer, your ND can advise you on how you can minimize your symptoms. However, just like cleaning up your room, the temporary discomfort is well worth it!
Do You Have 7 Days?
If you’ve been reading this and realizing that you can benefit from a detox, I’d like to invite you to join my 7 Day Detox program. It’s just 7 days of your life to get you feeling the benefits of a detox! Take a sneak peek here. I’d love for you join my growing list of patients who are taking advantage of this to kick-start their health! If an intense detox is not for you, that’s no problem either. I’ve done slower detoxes with patients for years with just as many benefits – it just takes a little longer to get there.
For those of you interested in my 7 Day Detox program, find out more about this revolutionary program here!
EWG Public Affairs (2009). Toxic Chemicals Found In Minority Cord Blood. Retrieved from: http://www.ewg.org/news/news-releases/2009/12/02/toxic-chemicals-found-minority-cord-blood
Hodges, R.E, and Minich, D.M. (2015). Modulation of Metabolic Detoxification Pathways Using Foods and Food-Derived Components: A Scientific Review with Clinical Application, J Nutr Metab, 2015: 760689.
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Fatigue is a very common concern that patients come to see me for in my Nepean and Orleans naturopathic practices. A lot of the time, patients have had a standard workup done with their medical doctor, but were told everything came back as “normal”.
You may find yourself in the same situation. You know you could feel better, but you don’t know what you can do about it. So, you keep dragging yourself from one day to the next with just barely enough energy to get through the day. Chances are, you CAN get better, and a naturopathic doctor can help you figure out what needs to change.
We all feel tired once in a while. If you’re wondering if your level of energy is normal or not, here are some signs that things could be better:
Of course, there are some basic lifestyle factors that can lead to fatigue. These are things that you would easily be able to identify yourself, like lack of sleep, a diet of highly processed food, or lack of exercise (which you may not be able to bring yourself to do if you are feeling very run down). What I’ll share with you today are the top 7 causes that I take into account when assessing a patient with longstanding fatigue. Keep in mind that there are many other causes. If these show up as optimal for you, then I’ll keep digging to find the cause of your fatigue.
#1 – Iron Deficiency OR Iron Overload
Most women who have regular menstrual cycles have sub-optimal iron levels. Furthermore, those who eat vegan or vegetarian diets are at greater risk of an iron deficiency. Even if you are not anemic (where iron levels drop to a minimum), you can still feel low in energy if your storage level of iron (ferretin) is sub-optimal. I generally aim for ferretin to be in the 60-80 range for women. Note that you could be in the “normal” levels with levels of ferretin as low as 10, but obviously you wouldn’t be feeling your best!
Before you go ahead and start supplementing with iron, do get your ferretin levels checked. It is possible to take too much iron, which can cause all kinds of problems long-term. Some people feel unwell because their body stores too much iron, a condition called hemochromatosis. I’ve seen this issue more commonly in men than in women, but it can happen in either.
#2 – Vitamin Deficiencies, Especially VitB12 And VitD
A Vitamin B12 deficiency is very common in vegans and vegetarians, so if you are eating little to no animal protein, you are probably deficient. However, even if you do eat meat regularly, it is possible to be B12 deficient. This can be due to problems assimilating the B12 from your diet due to issues such as malabsorption, food sensitivities, or low stomach acid. As well, if you are prone to depression or anxiety, you may need higher levels of B12.
Vitamin D deficiency is also very common here in Canada. It is very rare for me to measure a patient’s blood levels and find them in the optimal range if they are not supplementing with at least a minimal amount of Vitamin D. Adequate Vitamin D not only helps with energy, but it also helps with hormone balance, immune system support, skin health, and cancer prevention. Most people need prescription levels (i.e. >1000 IU per day) of Vitamin D at least temporarily, and getting your blood levels measured helps to individualize that prescription for you.
#3 – Blood Sugar Imbalances
If you crave carbs or sugary snacks and need that cookie to get your energy back up, a blood sugar imbalance might be behind your fatigue. Sugary foods can bring your energy levels up, but only temporarily. This is soon followed by a crash in energy, which will have you reaching for another quick source of energy. Having more balanced meals with plenty of protein and vegetables can help you keep your energy more even throughout the day. You can test this out by seeing how you feel after pasta dish compared to how you feel after a hearty chicken salad.
#4 – Sub-Optimal Thyroid Function
Hypothyroidism is a condition in which the metabolism slows down, and people generally feel more fatigue. If you’ve been diagnosed with this, you know how it feels. However, even if your doctor measured your thyroid stimulating hormone (TSH) and it was within the normal range, it could be functioning sub-optimally. If you suspect this might be a problem, see my post about the thyroid here.
#5 – Food Sensitivities
Reactions to food can have local effects (such as digestive symptoms of bloating, gas, diarrhea, constipation), but they can also lead to systemic effects, such as brain fog and fatigue. Many patients notice more energy once they go on a detox or elimination diet that removes the most common food sensitivities at once. You can find out if food sensitivities are playing a role in your fatigue either through an elimination diet, or through IgG food sensitivity testing.
#6 - Adrenal Fatigue
If you’ve been under chronic stress for a while, chances are you have adrenal fatigue. Your adrenal glands are little glands that sit on top of your kidneys and help you deal with stress. For short-term stress, they produce adrenaline, but for longer-term stress, cortisol is the prevalent hormone. Your cortisol levels vary throughout the day, so the best way to measure the health of your adrenal glands is through a 4-point salivary adrenal test (taken at 4 times during the day). We typically also test for other hormones in females when running this test, as being chronically stressed can wreak havoc on your other hormones.
#7 - Depression
This one doesn’t have a lab test to rule it out, but careful questioning can help your doctor assess if depression might be causing your fatigue. In this case, the fatigue can be mental/emotional, and you may not feel motivated to do things that used to be enjoyable for you. There are questionnaires, such as the Beck Depression Inventory, that can help us see where you stand. If you do have symptoms of depression, a naturopathic doctor can also see if some of the above factors could be contributing to you feeling depressed.
These are just some of the most common causes of fatigue I have seen in practice. As you can see, finding and treating the cause of your fatigue is key – only then will you be able to see lasting improvement in your day to day energy!
Do you want to wake up in the morning with a spring in your step and energy to last throughout the day? If yes, then I invite you to start your journey towards thriving with me!
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I am seeing more and more patients in my Ottawa practice affected by autoimmune disease. Some of the more common autoimmune diseases I encounter are Hashimoto’s thyroiditis (a form of hypothyroidism), Graves' disease (a form of hyperthyroidism), Celiac disease (a strong intolerance to gluten), psoriasis (autoimmunity affecting the skin) and rheumatoid arthritis (autoimmunity affecting the joints). There are also some conditions that are not commonly thought of as autoimmune, but may have an autoimmune component and therefore fall on the autoimmune spectrum, including eczema and endometriosis.
An interesting question to ask is: What do all these conditions have in common?
What Is Autoimmunity?
Autoimmunity literally means that your immune system is reacting to components of your own body as if they were foreign invaders! As your immune system develops during infancy, it is trained to differentiate self from non-self, so that it can accurately distinguish what can be harmful to you and what isn’t. Unfortunately, with autoimmunity, the immune system becomes confused and starts to attack self.
The 3 Major Contributors To Autoimmune Disease
Most people come and see a healthcare practitioner only after they have had symptoms of autoimmune disease for a while, making it difficult to pinpoint and study the origin of autoimmune disease. However, because of the growing incidence of autoimmune disease in North America, there has been more interest recently to study this in more depth. It has been found that there are 3 main triggers for autoimmune disease (Campbell, 2014; Ballantyne, 2013):
Various environmental factors can also trigger autoimmune disease. These include bacterial and viral infections (that result in the formation of autoantibodies because the bacteria or viruses’ proteins look similar to our own proteins), heavy metals, chemical toxicants, silicone breast implants, emotional stress, vitamin and nutrient deficiencies, and drugs (Campbell, 2014; Ballantyne, 2013; Myers, 2015).
Last but not least of the 3 known triggers is a leaky gut (aka increased intestinal permeability). This is perhaps THE most important trigger.
The current research suggests that leaky gut is a NECESSARY precursor to autoimmune disease! That means that, even if you have the genetic susceptibility and an environmental trigger but if your gut barrier is intact, you won’t develop autoimmune disease. Isn’t that great news?
The current research suggests that leaky gut is a NECESSARY precursor to autoimmune disease!
What Is “Leaky Gut”?
Your gut is a continuation of your skin inside of you, and as such, it functions as a barrier between the outside world and the inside world. Therefore, to work properly, it can’t just let anything through into the bloodstream. There are tight junctions between each cell of the gut lining preventing most things from reaching the bloodstream before they are properly digested. Also, a huge part of your immune system is found right within the tissues surrounding the gut, sampling what’s coming in and making sure it’s “safe”. Beyond your own cells, the beneficial bacteria in your gut are also essential for proper digestion and immunity, and also act as a line of defence to prevent pathogens from getting through.
When your gut barrier becomes compromised and hyperpermeable, it allows food particles and pathogens through which shouldn’t be there. A gut can become leaky through (Ballantyne, 2013):
What Can You Do To Help Repair A Leaky Gut?
Fortunately, there are many things you can do to help heal a leaky gut! It does require a lot of work, since no supplement can replace improving your diet and lifestyle. Avoiding some of the food triggers that damage the gut and replacing them with whole, unprocessed foods is extremely important for lasting changes. You can identify your food triggers through a specific elimination diet. IgG food sensitivity testing can also be helpful to guide you in avoiding foods that are causing the most damage in your case. Supplements to help eliminate toxins and heal the gut lining are also very important, but you need to eliminate the triggers first before supplements can do their job properly. Stool testing can identify if you have an imbalance in your good gut bacteria. Stress management is also critical in helping your gut heal. A chronic leaky gut can also lead to malabsorption of vital nutrients that are necessary to help your gut heal, so I often do some testing to target supplementation to what each specific patient needs. Re-inoculating the gut with specific probiotics is also very important.
I have seen many patients’ health improve after we implement an individualized protocol based on these principles. The changes can sometimes be very dramatic! If you are suffering from an autoimmune condition and are ready to make some diet and lifestyle changes, I invite you to come on in for an initial assessment. I’d love to help you!
Now, I’d like to hear from you!
What autoimmune condition have you struggled with? Have you seen dietary and lifestyle changes make an impact on your health? Can you identify with some of the triggers I’ve mentioned?
Ballantyne, S. (2013). The Paleo Approach: Reverse autoimmune disease and heal your body. Las Vegas, Nevada: Victory Belt Publishing.
Campbell, A. W. (2014). Autoimmunity and the Gut. Autoimmune Diseases, 2014, 1-12. doi:10.1155/2014/152428
Myers, A. (2015). The Autoimmune Solution: Prevent and reverse the full spectrum of inflammatory symptoms and diseases. New York, New York: Harper One.
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If you’re wandering down any typical grocery store in Ottawa, you will usually come across one isle or two promising “freedom” from some of the typical things most people eat: gluten-free, dairy-free, egg-free, soy-free, and the list goes on. You may have wondered if those foods are healthier, and if you should also be filling your grocery cart in that isle.
Food sensitivities and allergies are on the rise in North America. It’s hard to plan a kids’ party without someone having some dietary restrictions. So, what’s the difference between food sensitivities, intolerances, and allergies?
Most people with food allergies found out the hard way. They ate some peanuts and had difficulty breathing, or ate some strawberries and broke out in hives. These reactions are usually severe, and are mediated by a type of antibody called IgE (antibodies are produced in the body and attach to specific protein sequences that they recognize). If you went to an allergist and got pricks in your forearms, you were most likely tested for IgE reactions.
Symptoms of food allergies usually show up fast, usually starting within 15min of consuming the food, and can be quite severe. They are the type of food reaction that is usually immediate, and are associated with anaphylaxis. If you have a food allergy, you have to be very careful about avoiding even trace amounts of the food in question.
Food sensitivities are typically harder to pinpoint than food allergies, so many people go undiagnosed for years. They are delayed reactions to food mediated by a different type of antibody, IgG. Symptoms occur most commonly within the first day of eating a food, but can occur up to 3 days after. The symptoms of a food sensitivity tend to be more subtle than a food allergy. They can include:
-digestive issues (bloating, gas, diarrhea, constipation, etc.)
-feeling like food “just sits there” and doesn’t digest well
-difficulty losing weight
-skin issues (acne, eczema, psoriasis)
-behavioural issues in children
Food sensitivities can be identified either through an elimination diet, or through IgG food sensitivity testing. Many patients opt for IgG food sensitivity testing to get a more objective starting point of which foods to start eliminating. This involves a simple blood test that will look at the level of IgG produced with respect to 120-200 foods. However, food sensitivity testing is still controversial. It is not 100% accurate, must be interpreted in the light of what is going on with the patient, and possible cross-reactions (i.e. shellfish IgG can show up high in someone with a dust allergy because the body recognizes a similarity between them). False positives can occur if the patient has a condition referred to as leaky gut syndrome (where the bowels are hyper-permeable and allow too many undigested foods through). False negatives can occur if you have not been eating a certain food, so it is better to do the testing before you start eliminating foods from your diet.
In research studies, IgG-based elimination diets have been found to help with:
-both migraines and irritable bowel (Aydinlar et al., 2013)
-IBS (Drisko et al., 2006; Atkinson et al., 2004)
-Crohn’s disease (Bentz et al., 2010)
Despite the lack of conclusive research, I have found the test to be very clinically relevant in practice: most of my patients with the relevant symptoms improve quite dramatically when we remove their food sensitivities from their diet.
Reading through articles can be confusing, since the term “food sensitivities” and “food intolerances” is often used interchangeably. However, food intolerances are non immune-mediated reactions to food (no antibodies are involved). Typically, the body will lack something which will make it intolerant to a food. A common food intolerance is lactose intolerance, where one cannot tolerate lactose-containing dairy products because he/she lacks the lactase enzyme in the digestive tract necessary to break down lactose. With lactose intolerance, symptoms usually occur within 30min of consuming lactose, leading to stomach cramps, abdominal pain, and diarrhea.
An elimination diet can help identify both food sensitivities and food intolerances. It may take some further testing after that to identify if, for example, your reaction to dairy is due to a sensitivity or an intolerance.
What To Do About Them
Once you identify which foods are a problem for you, there are healthy and not-so-healthy ways to eliminate them from your diet. Many of the specialty foods free of common allergens/sensitivities are highly processed, and contain fillers, emulsifiers, and sugars to make the texture or flavour more similar to their regular counterparts. Your best bet is to stick with whole foods that are minimally processed most of the time, and only have the processed ones as an exceptional treat. You may also need additional supplements to help heal your gut barrier so that you can potentially tolerate your sensitivities more in the future.
Do you think you may have a reaction to a food you are consuming? If you have any questions or would like to get started on an elimination diet or IgG food sensitivity testing, please contact me at either of my Ottawa offices, in Nepean or Orleans.
Atkinson W1, Sheldon TA, Shaath N, Whorwell PJ.Gut. Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial. Gut. 2004 Oct;53(10):1459-64.
Aydinlar EI1, Dikmen PY, Tiftikci A, Saruc M, Aksu M, Gunsoy HG, Tozun N. IgG-based elimination diet in migraine plus irritable bowel syndrome. Headache. 2013 Mar;53(3):514-25.
Bentz S1, Hausmann M, Piberger H, Kellermeier S, Paul S, Held L, Falk W, Obermeier F, Fried M, Schölmerich J, Rogler G Clinical relevance of IgG antibodies against food antigens in Crohn's disease: a double-blind cross-over diet intervention study. Digestion. 2010;81(4):252-64.
Drisko J1, Bischoff B, Hall M, McCallum R. Treating irritable bowel syndrome with a food elimination diet followed by food challenge and probiotics. J Am Coll Nutr. 2006 Dec;25(6):514-22.
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Many people come to me at my Ottawa practice because they have difficulty losing weight and feel that their metabolism is slowing down. Your master gland for controlling metabolism in the body is your thyroid gland, a butterfly-shaped gland at the base of your neck. It is estimated that thyroid disorders affect 0.5-0.8% of the population, but those estimates may be on the low side. Naturopathic doctors such as myself who have taken additional training are now able to prescribe natural desiccated thyroid to help restore optimal thyroid function.
Many people have been told that they have normal thyroid function after an initial screening test (TSH), but on further testing, one or both of their thyroid hormones are off. So, I usually screen my patients who experience several low thyroid symptoms with a full thyroid panel to make sure that their thyroid is functioning optimally.
Symptoms of Hypothyroidism
What are low thyroid symptoms? If you think about it, if your metabolism is slowing down, you will see repercussions throughout the body. Digestion will slow down, thinking will slow down, and the pounds will start adding up. Here is a list of common signs and symptoms of hypothyroidism:
-Dry and coarse skin
-Difficulty tolerating cold temperatures
-Sluggish digestion and constipation
-Puffiness (you may notice puffiness in the face)
-Slow heart rate
-Delayed relaxation of ankle reflexes (this is tested during a physical exam)
Having several of these symptoms does not necessarily mean that you have a thyroid issue. Many of these symptoms are non-specific, so they may be due to many other imbalances in the body. That’s why testing is so important.
Testing for Hypothyroidism
I usually do a full thyroid screen when I test for thyroid disorders, which includes:
If you thought you had a thyroid issue or your doctor suspected it, you’ve probably had your TSH (thyroid stimulating hormone) tested. This hormone is secreted by the pituitary gland (at the base of your brain) and acts as a manager to tell the thyroid what to do.
If the thyroid isn’t producing enough thyroid hormones, TSH will typically be high, as the manager is working hard, trying to get the thyroid to do its job. However, there is a huge “normal” range for TSH. If you’re within the normal range but still have symptoms, your levels may be sub-optimal. As a naturopathic doctor, I’m checking to see if you’re actually within the optimal range, which is a smaller sub-section of the normal range.
The next hormone to look at is your free T4 levels. This is a pro-hormone produced by the thyroid which needs to be converted to free T3. It’s the free T3 that is actually active within the tissues, speeding up your metabolism. If you’ve been taking Synthroid or its generic form, levothyroxine, you are getting synthetic T4. This T4 needs to be converted into free T3. However, many people take Synthroid, regain normal TSH and fT4 levels, but still have low thyroid symptoms because they are not converting the fT4 into fT3 properly. That conversion process depends on many things, including stress levels, heavy metal exposure, and minerals such as selenium and zinc.
TPO antibodies are useful for screening for Hashimoto’s thyroiditis, an auto-immune condition where the body misguidedly attacks its own thyroid tissue, leading to hypothyroid symptoms. If you have this, it makes a big difference in how you will be treated from a naturopathic perspective, because our treatments will not only be aimed at getting thyroid function back, but also at decreasing the auto-immune response using diet, lifestyle, and supplementation.
What Affects Conversion of T4 into T3?
The conversion of T4 (inactive) into T3 (active) requires many factors to be in place for it to work optimally. The deiodinase enzyme is the enzyme through which this reaction takes place. This enzyme can be slowed down by (Hui, 2016):
-Lack of progesterone (common as women enter perimenopause)
-Low or high cortisol levels
-Toxins and heavy metals such as mercury
-Inadequate selenium, zinc, and other trace minerals and vitamins
-Stress or many chronic diseases
Why Desiccated Thyroid?
Desiccated thyroid is not for everyone affected with hypothyroidism. However, now that you have a basic knowledge of how the thyroid works, you’ll understand why someone might require desiccated thyroid rather than Synthroid (only T4). Desiccated thyroid in Canada, called Erfa, is a standardized natural extract from a porcine source. Since it contains both T4 and T3, it can be especially useful for those who convert T4 poorly to T3. As well, since it is an extract of the whole thyroid gland, it also contains other nutrients that act as building blocks for the thyroid to function properly. In a randomized, double blind, crossover trial, when patients spent 12 weeks on Synthroid followed by 12 weeks on desiccated thyroid, or the other way around, 43% of patients preferred desiccated thyroid over Synthroid while only 19% preferred Synthroid (Hoang et al., 2013). Those on desiccated thyroid also tended to lose more weight.
As with other drugs, patients on desiccated thyroid must be closely monitored to make sure that they are on an optimal dose for them which does not cause any side-effects.
Is Desiccated Thyroid For You?
If you would want to find out if desiccated thyroid is a good option for you, book an appointment at either of my locations, and I would be happy to help you out! We will do a thorough assessment and see if you would be a good candidate, or if there are other avenues that should be explored first (or in conjunction).
If you think your health issues may be related to your thyroid, just give one of my Ottawa offices a call!
Hoang TD et al. Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: A randomized, double-blind, crossover study. J Clin Endo-crinol Metab 2013;98:1982-90. Epub March 28, 2013.
Hui F. Clinical Pearls in Assessing & Treating The Thyroid. Evidence Based Nutrition Module 3: Bio-identical Hormones Conference. February 2016.
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Dr. Tamar Ferreira is a Naturopathic Doctor in Brampton, Ontario. Her areas of focus include digestive health, hormone balance, and skin conditions.