I am seeing more and more patients in my 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, 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 us and we'll help you out!
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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The Inside Scoop On Natural Desiccated Thyroid Treatment For Low Thyroid Function
Many people come to me at my 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 us 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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Hormone Imbalance? You May Benefit From Bio-Identical Hormone Replacement Therapy
I am very excited to announce that I will be integrating bio-identical hormone replacement therapy (BHRT) into my practice very soon! I am getting additional training at the end of February at a bio-identical prescribing conference in Toronto, where I will learn clinical pearls from leading integrative medical doctors and naturopathic doctors.
So, what is all the fuss about bio-identical hormone therapy? Let me clarify a few things for you.
What is bio-identical hormone replacement therapy?
BHRT is the use of biologically and structurally identical hormones to those naturally found in the human body for the purposes of replacing hormones that are found to be lacking. BHRT is most commonly used in women to help with the symptoms of peri-menopause and menopause. However, imbalances in estrogen and progesterone are found in younger women as well, and these women can also benefit from bio-identical hormone replacement therapy carefully timed to their menstrual cycle.
Who can benefit from BHRT?
Women with the following symptoms and hormonal imbalances may benefit from BHRT:
-Sleep disturbances that are hormone-related
-Polycystic Ovarian Syndrome (PCOS)
-Depression, anxiety, and mood swings
I heard that hormone replacement therapy is dangerous. How would bio-identical hormone replacement be any better?
The well-known Women’s Health Initiative study (WHIS), which was published over 10 years ago, highlighted the dangers of conventional replacement therapy, with increased risks of heart disease, stroke, blood clots, and dementia in those taking a combination of Premarin® (conjugated equine estrogens) and Provera® (synthetic progestins). This study looked at the use of non-bio-identical hormones that resemble but are not identical to our human estrogen or progesterone. That is key. Premarin® is a mix of conjugated horse estrogens (extracted from the urine of pregnant mares), only 50% of which are identical to human estrogen. The other 50% are not well recognized by our body. Provera® is a synthetic progestin, which is structurally different from progesterone. The lowest risk in the WHIS study was in those who were treated with Premarin only. This may be because Premarin contains 50% bio-identical estrogens.
But, we can do better! We can use 100% bio-identical hormones. We can also have the exact amount you need compounded for you based on your levels, which makes it a very individualized process. Furthermore, we now know that giving estrogen as a cream (transdermally) is much safer than giving it orally. Because bio-identical hormones cannot be patented, funding for large studies is harder to find. While there are no very large trials of bio-identical hormone replacement yet, we are seeing more studies with hundreds of participants confirming that BHRT appears to be effective and substantially safer than conventional hormone replacement.
How do you determine what’s going on with my hormones?
Before starting bio-identical hormone replacement therapy, I will do a full naturopathic assessment, and look at the roles that your diet, lifestyle, adrenal glands, thyroid, and liver play in keeping your hormones in balance. If these underlying aspects are not addressed, you may not see as big of an improvement as one would expect from bio-identical hormone replacement therapy.
We will also need to do a baseline assessment of your hormones, usually using salivary hormone testing. I will then work with a compounding pharmacist to prepare an individualized bio-identical topical cream or vaginal suppository, based on your needs. Once we start treatment, we will monitor your hormones periodically and make changes as needed.
BHRT is only one part of the puzzle
Don’t forget that health is multi-faceted. Replacing one or two deficient hormones can be extremely helpful, but supporting the health of your entire body is vital for enduring health. As I mentioned earlier, addressing underlying causes and supporting the function of the liver, adrenal glands, and the thyroid are extremely important for lasting hormone balance.
If you are interested in pursuing BHRT to help with your hormone imbalance symptoms, I invite you to make an appointment with me starting March 1st, 2016. Just give us a call, and we’ll get you set up!
Gillson, G., & Marsden, T. (2004). You’ve Hit Menopause: Now What? Calgary, AB: Rocky Mountain Analytical Corp.
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Are you looking for a healthcare provider that will take the time to understand and get to the bottom of WHY you’re not feeling your best? Do you want someone on your team that will help you be your healthiest, using a natural approach that aims to address the root cause(s) of why you don't feel your best? A naturopathic doctor is probably what you’re looking for. However, even among naturopathic doctors, there are a variety of approaches, special interests, and personalities which make us unique. Here are a few things to look for so that you can find the perfect fit for YOU.
1. Licensing and Additional Training
All naturopathic doctors in Ontario should be registered under the College of Naturopaths of Ontario (CONO) (www.collegeofnaturopaths.on.ca). If you find your naturopath here, it means that they have a good, solid naturopathic medical training (university-level premedical requisites, 4 years of naturopathic medical training at an accredited school, and North American and Ontario board exams afterwards). Additionally, as of July 1st, 2015, naturopathic doctors who write and pass a prescribing exam can prescribe certain substances, including high dose vitamins, bio-identical hormones, and desiccated thyroid hormone. As this is fairly new legislation, many naturopathic doctors are still in the process of getting the certification needed in order to prescribe. If you’re a cancer patient, then you probably want to find someone with additional IV therapy training. You can find all this information on the CONO website, under the Naturopathic Doctor Register.
2. Knowledgeable about Your Health Concerns
Naturopathic doctors don’t specialize, but many have developed a more specific niche that they have focused more of their practice on. Take a look at their website, as well as their Facebook and Twitter posts, to see if some of the content they have posted speaks particularly to you. In my case, I have a particular interest in digestive issues, hormone imbalances, and skin conditions. Over the years in clinical practice, I have found that many of these are inter-related and benefit from a multi-faceted, holistic approach. It gives me so much joy to be able to help my patients overcome their often chronic health conditions!
3. A Good Teacher
One of our core principles that we adhere to, as naturopathic doctors, is ‘docere’, which means, ‘to teach’. A good naturopathic doctor should not just send you home with a bag of supplements. Sooner or later, your ND should take the time to teach you how to make healthier diet and lifestyle changes every day, in a way that you feel you can realistically implement and that is unique to YOUR needs. I believe that healthy diet and lifestyle are the cornerstone foundations of health, and that they are what will help keep you healthy for as long as possible. Yes, supplements are often needed, and more supplements may be needed at specific stages in your healing journey, but make sure that you understand why you are taking each one of them, and how long you should be taking them for.
4. A Good Listener
Naturopathic doctors usually have much longer appointments and follow-up appointments than what you’ve been used to with your medical doctor. They’ll be taking the time to hear your unique story, your highs and lows, and your personal struggles and victories. All the while, they’ll be trying to put together the pieces of the puzzle, in order to help pinpoint what may have caused your symptoms. You’ll likely be sharing a lot with your naturopathic doctor, so making sure that you feel comfortable with them even before becoming a patient is ideal. You will want someone who will listen attentively and with empathy, and will take your goals and preferences into account. I offer a free 15min meet-and-greet session to give us an opportunity to break the ice, answer your general questions, and see if we’re a good fit.
5. Your own Private Detective
You want someone who wants to see you get better, and who will explore all aspects of your health. As a naturopathic doctor, I usually start with the treatments and/or testing that is likely to most benefit the patient, at the lowest cost possible. However, there are those times when things are more complicated, and we have to take a step back and re-evaluate. For example, I have had several patients with irritable bowel syndrome who did not respond as well as expected to food sensitivity elimination. We did some further testing, and it turns out that they had a previously undetected chronic parasitic or fungal infection that needed to be treated. You want someone who will take your concerns seriously and will take the time to get to the bottom of them.
Are you ready to make some positive changes in your health? Learn more about my approach, on www.tamarferreirand.com. I’ve helped many people in the Brampton area just like you who have been looking for answers to their health concerns take control of their health and feel vibrant and energized again! Call us at Downtown Brampton Wellness Centre (905-451-3963) to schedule a free 15min meet-and-greet appointment, or to get started with an initial visit.
Updated Mar 2020 to reflect my current practice location.
Homemade Electrolyte Drink Recipe
After a few cooler days here in Ottawa, it seems like we are heading into some warm weather this week. It's very important not only to rehydrate if you've been sweating, but also to replenish important electrolytes that you lose while you're sweating. If you're one of those people who gets headaches after exercising, you may not be replenishing your electrolytes enough. And while many people will reach for a product like Gatorade or Vitamin Water in an attempt to replenish electrolytes, there are much healthier alternatives out there... Or, actually, right in your kitchen!
I've recently had many patients ask me for an easy, homemade electrolyte drink recipe. Here's one that I have enjoyed today after my morning run:
In a large 500mL glass, mix together:
-juice of 1/2 lemon
-1/8-1/4 tsp of sea salt (it should taste slightly salty)
-1/8-1/4 tsp of baking soda (same amount as sea salt; it will bubble and fizz when you add it in!)
-1 tsp honey or maple syrup
Then add water to fill the glass.
That's it! So easy - enjoy!
5 Hidden Causes of Weight Gain
Over the years, I have seen many patients who have been struggling with their weight in my Ottawa practice. Many have tried multiple strategies without lasting success before coming to see a naturopathic doctor. Trying to lose weight can be an emotional roller coaster, and is often not simply a matter of willpower and portion control. The only way to truly make a difference in the long run is to address the underlying cause(s) of weight gain.
I am excited to share with you some of the key points I talked about in my recent “Wellness for Weight Loss” seminars at the Ottawa Public Library. These are my top 5 weight loss sabotagers that I screen for in patients who are having difficulty losing weight.
Top 5 Hidden Causes of Weight Gain
Despite the large amount of food available to us, most North Americans following the Standard American Diet (appropriately referred to as the “SAD” diet) are overfed but undernourished! This diet is low in essential nutrients that are needed for proper metabolism and hormone balance. Without these nutrients, we can experience hunger even while eating larger quantities of food, since the body is still starving for those nutrients. Eating a whole food, varied diet, high in vegetables and omega-3 fatty acids, can help decrease inflammation in the body and help with proper hormone balance.
2. Blood Sugar Imbalances
Some carbohydrates in foods convert to sugar in the bloodstream faster than others. To prevent excessive storage of blood sugar into fat, you want your blood sugar to stay tightly regulated, with no sharp rises or dips. This is because sharp rises in blood sugar triggers the release of insulin, a hormone that controls blood sugar levels and storage into fat. As long as insulin levels are high, you cannot burn fat from adipose tissue because your body is focusing on storing excess blood sugar into triglycerides and then into fat cells. Foods that are high in simple carbohydrates and low in protein and fibre will cause an initial spike in blood sugar, leading to an initial energy boost. However, this is short-lived and is quickly followed by a dip as the sugar is taken up into cells and stored, leading to low blood sugar, low energy, and hunger cravings. And what do we typically reach for when we are hungry and in a hurry? High carbohydrate foods, which just perpetuate the cycle! Keeping your blood sugar more even by eating the right foods can make a big difference.
3. Food Sensitivities
Many people have underlying food sensitivities which are causing inflammation in their body, hindering weight loss. Identifying and eliminating food sensitivities may decrease chronic inflammation which fuels obesity. Food sensitivities are delayed immune-mediated reactions to foods, which can occur anytime from eating the food and up to 72 hours after. The body can produce excessive amounts of a type of antibody called immunoglobulin G, or IgG, which recognizes and attaches to specific proteins in food particles. (This is different from the typical anaphylactic allergic reactions we hear about, which are mediated by a different type of antibody called IgE.) Common symptoms of food sensitivities include digestive issues (gas, bloating, constipation, diarrhea), feeling like food “just sits there”, foggy thinking, migraine headaches, fatigue, difficulty losing weight, or skin issues (acne, eczema, psoriasis). If you suspect that you might have a food sensitivity, a naturopathic doctor can help you identify problematic foods through IgG food sensitivity testing (blood test) or an elimination diet.
4. Chronic Stress
All of us go through stressful periods. Usually, we can recover after a short-term stress and go on with our lives. However, we often don’t realize the detrimental impact of long-term, chronic stress on our bodies. Our body deals with any long-term stress through the adrenal glands (“ad” means “near” and “renal” means “the region of the kidneys”), which produce cortisol. If you tend to gain weight in your mid-section, chances are chronic stress (or sugar imbalances) may be an issue. Over time, high cortisol leads to the breakdown of muscle mass (decreasing metabolic rate), decreased production of active thyroid hormone, depressed mood, cravings for sweets, fats, and salty food, and central weight gain. Learning stress management tools and using the appropriate nutritional supplementation can help you improve your metabolism and help you lose weight around the middle.
5. Thyroid Dysfunction
Optimal thyroid function is very important for anyone who is trying to lose weight. The thyroid controls metabolism and therefore weight. An underactive thyroid, or hypothyroidism, is associated with weight gain, depressed mood, cold intolerance, constipation, and many other symptoms. Think about what would happen in your body if you slowed down how quickly everything worked, and you could explain most symptoms of hypothyroidism. If you have symptoms but your thyroid has been tested and found to be “normal”, there still could be a problem with your thyroid. I look for optimal rather than normal levels in those patients, and often order a complete thyroid panel (TSH, fT3, fT4, TPO) to make sure everything is functioning as well as it could. As mentioned above, chronic stress can also impair the way thyroid hormone is used by the tissues, and may be a reason you could have symptoms when your lab tests appear normal.
So that’s it: 5 underlying causes of weight gain to look out for! Are there any that you think could apply to you? If you have been struggling with weight for some time and want to treat the underlying cause, come on in for a visit at my clinic!
Guest post by Dr. Justin Gallant, ND. See original post here. I have had many patients recently come in with sleep maintenance insomnia, and Dr. Gallant explains very nicely why this may happen.
Almost 80% of the patients who walk through my door wake up around 1-3am. The most common reason for this is hypoglycemia. Once I get them eating a small snack with protein before bed their sleep-maintenance insomnia usually subsides.
There are several other reasons for waking up around this time but clinically I have seen low blood sugar as being the most common. If having a snack before bed doesn’t cut it and you’re still waking up in the middle of the night you should definitely talk to your Naturopath or Medical Doctor about it, especially if you're having other symptoms. Many people say eating before bed will cause you to gain weight but a small snack may actually help you lose weight as I discuss further down.
Protein helps glucose get into your cells more efficiently via insulin and is converted to glucose much slower than if you were to just eat sugar. Fiber slows your absorption rate of glucose so both protein and fiber will help keep your blood sugar stay stabilized while you’re sleeping. Protein also provides amino acids that are necessary for neurotransmitters like serotonin, dopamine and GABA (which I mention below) to be made. Every action has a reaction so if you eat that donut your blood sugar will sky-rocket and then plummet soon after. Your goal should be to keep your blood sugar as close to the midline in the picture above as you can and aim to have blood sugar regulated until cortisol is naturally elevated when it's time to wake up.
A piece of bread with peanut butter
Legumes like chick peas, beans, nuts, seeds
Soup or stew
Protein shake or protein bar
Veggies, crackers or pita dipped in hummus.
Stay away from simple carbs and sugary snacks like fruit before bed as they’ll just temporarily elevate your blood sugar and it will come crashing down soon after, increasing the likelihood of hypoglycemia while you’re sleeping.
Explanation of why you wake up:
During the night your liver is working hard at metabolizing glucose and your brain is actively organizing your thoughts and dreaming. If you eat dinner at 5 or 6pm and then try to go until 8 or 9am without any food you’re going to get hypoglycemic just like you would if you tried to go 14 hours without food during the day. Once our sugar gets too low we pump out cortisol from our adrenal glands. Cortisol is one of our stress hormones. We pump it out naturally to increase our blood sugar but since it’s a stress hormone it wakes us up. Cortisol also inhibits GABA, which is an inhibitory neurotransmitter which helps keep us calm and relaxes our muscles. So now you’re stressed and can’t relax…thanks a lot brain, I thought you were smart? Once our blood sugar gets too low we must secrete cortisol for survival. Our brains use ~30% of the glucose we take in and even though we’re sleeping, each cell in our body needs glucose for fuel.
Eating a snack before bed will actually help you lose weight! Bold statement right? Well think about it. If you’re going 10-14 hours without food your body is going to go into famine-mode. It thinks once it gets breakfast that you could go another 12 hours without food so it’s going to store whatever you put into it as fat to be used for energy later. This is the equivalent of your Uncle Bob carrying a bunch of Jerry cans full of gas in his ol’ pick up so he doesn’t have to keep going to the gas station when he’s running on fumes.
There are plenty of other reasons why we wake up in the middle of the night which can be exacerbated by hypoglycemia as well. For instance, if you have Benign Prostatic Hyperplasia (BPH), you may be waking up around 3am because you have to pee. Most men attribute this to the BPH but once I get these guys eating properly and having a snack before bed the urge to urinate doesn’t wake them up anymore. It’s more of a combo of something is going on in your body that would wake a light sleeper but if you can get into the deep sleep, you won’t be so sensitive to it. This effect can happen with almost any symptom that’s preventing you from sleeping (i.e. bloating, pain, flatulence, snoring, etc…). Our bodies are programmed to turn our senses off while we’re sleeping, but if we pump out cortisol we’re going to wake up and those senses will re-engage. Once our senses re-engage we will be able to perceive those internal and external stimuli that we wouldn't have noticed while in a deep sleep.
Besides feeling terrible, insomnia comes with its complications as well which are too plentiful to discuss in this article but can involve weakening your immune system, emotional strife, poor work performance, side effects from caffeine and poor-decision making to name a few.
Other causes of sleep-maintenance insomnia:
A restless partner
Restless Leg Syndrome (RLS) - I'll be blogging about this soon!
Congestive Heart Failure
Sleep paralysis, hypnopomp, astral catalepsy, whatever you want to call it.
Nutrient deficiency (Iron most commonly)
Respiratory conditions like COPD, Lung cancer, etc…
High or low blood pressure
Segmented sleep, bimodal sleep pattern, biphasic or polyphasic sleep
Pelvic floor weakness
Medication side effect
According to Traditional Chinese Medicine, waking up between 1-3am could indicate your liver needs attention. This could be due to anger issues, dietary, excess alcohol, etc… Sometimes just doing acupuncture, taking Chinese herbs or dealing with diet or anger can completely resolve sleep-maintenance insomnia.
Thanks for reading!
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Dr Justin Gallant ND
Jane*, a 33-year-old woman, came to see me with a chief concern of pregnancy achievement. She had one early miscarriage (chemical pregnancy) 5 months before, and had been trying to conceive again since then. Her medical doctor had suggested fertility treatments if she was not pregnant within the next 7 months, but she preferred pursuing a more natural approach.
Pregnancy achievement can be a long, emotionally-charged process for many women. If they have a history of miscarriage, they may have a lingering fear that this may happen again, which can add stress and anxiety. While there are many factors which influence overall fertility in women, achieving hormone balance is one of the key ways to prepare the body to conceive and sustain a pregnancy. Naturopathic doctors have much to offer to help balance hormones and optimize chances of conception.
Clues that you may have a hormone imbalance include irregular cycles, painful or heavy periods, mid-cycle spotting, migraines, low cervical mucous production, or PMS symptoms. You may have been diagnosed with hormone-related conditions linked with sub-fertility, such as endometriosis or polycystic ovarian syndrome (PCOS). Blood tests and/or saliva testing at specific times of a woman’s cycle can be ordered by a naturopathic doctor to help identify imbalances.
However, one of the best non-invasive tools that we have for assessing whether a woman’s hormones are in balance is through the charting of particular signs and symptoms throughout her menstrual cycle, using a system such as the Fertility Awareness Method or the Creighton FertilityCare charting system (Pallone et al., 2009). This information gives your doctor a better idea of which hormones may be out of balance. For example, spotting or brown bleeding between menses usually indicates a progesterone deficiency (Rouchotas, 2014). Charting also allows you to identify your ‘fertile window’, the stretch of approximately 6 days per cycle during which you could conceive (Pallone et al., 2009). In subfertile couples, this window may be as short as 2 days, and identifying the precise “fertility window” can help the couple conceive (Stanfordet al., 2003).
In the case of Jane, learning to chart and careful tracking allowed her to find out that she was not ovulating on the typical Day 14 of her cycle, but a few days later on Day 17. Since experiencing her miscarriage, her cycles varied from 31 to 34 days, when they had previously been more regular. She experienced cramping around the beginning of her menses, and suffered from frequent headaches and migraines. To help regulate her hormones, we began her on a seed protocol, which included estrogenic seeds in the first half of her cycle, followed by progesteronic seeds during the second half of the cycle. I also prescribed fish oil, magnesium, Vitamin D, and optimized her diet. She was already on a prenatal multivitamin. We then began acupuncture treatments timed specifically with her cycle. I often use acupuncture to enhance fertility because of its role in regulating hormones and assisting ovulation through its effects on the nervous system (Yu et al., 2013). After 4 acupuncture treatments, she postponed her 5th treatment, as her menses had not returned and pregnancy was suspected. She later informed me that she was indeed pregnant and doing well.
Every couple’s conception story is unique, and can be more complex than Jane’s case. Treatment is individualized and addressed from a holistic perspective. Because hormones play a such a significant role in conception and a healthy pregnancy, it is usually best to treat any identified hormonal imbalance prior to attempting pregnancy. The liver is an important organ for processing and eliminating excess hormones, and therefore supporting proper liver function using supplements and dietary changes is one of the cornerstones for balancing hormones naturally. Women who have recently been on hormonal contraceptives may be in particular need of liver support to help clear those exogenous hormones. Any detoxification protocol should be done as a preparation measure and not while attempting to get pregnant, as toxins are mobilized before they are eliminated and could potentially affect the developing baby. Depending on the condition, herbs such as chaste tree may be used to help regulate the cycle (Roemheld-Hamm, 2005). Your naturopathic doctor may also include other approaches to help prepare your body for conception, including eliminating hormone disruptors and food sensitivities from the diet, eating organic foods, managing stress, getting adequate exercise, and nutritional supplementation. In advanced cases of endometriosis or fibroids, co-management with a medical doctor may be necessary. It is also best when the health of both partners is optimized, since the health of the sperm also affects conception and the health of the infant.
Naturopathic doctors can help you understand your cycle and get you as healthy as possible to optimize your chances of conception. If you suspect you may have hormonal imbalances, the best time to take the measures to get healthy is now. Not only will you be more likely to maintain a healthy pregnancy, but you will also be improving your own long-term health.
*Name has been modified to protect patient’s privacy.
Pallone, S.R., and Bergus, G.R. (2009). Fertility Awareness-Based Methods: Another Option for Family Planning, J Am Board Fam Med, 22 (147-157).
Roemheld-Hamm, B. (2005). Chasteberry, American Family Physician, 72:5 (821-824).
Rouchotas, P. (2014). FertilityCare Toronto: A Restorative Approach to Women’s Health,Integrated Health Practitioners, Feb/Mar 2014 (31-35).
Stanford, J.B., Smith, K.R., and Dunson, D.B. (2003). Vulvar mucous observations and the probability of pregnancy, Obstet Gynecol., Jun; 101:6 (1285-1293).
Yu, J.S., Zeng, B.Y., and Hsieh, C.L. (2013). Acupuncture stimulation and neuroendocrine regulation, Int Rev Neurobiol., 111 (125-140).
Gut Feeling: The Brain-Gut Connection
Published in To Your Good Health, a natural health journal, Winter 2014, Issue #1
Does our gut really have the capacity to “feel”? If you have ever had food cravings when you are feeling down, or digestive upset in anticipation of a stressful event, then the connection certainly appears to be as real as anything else you experience. In fact, research in the growing field of psychoneuroimmunology (which looks at how the fields of psychology, neurology, and immunology blend together) shows that the nervous system of the gut, called the enteric nervous system (ENS), responds to more than 30 neurotransmitters. In fact, the ENS contains approximately 95% of the body’s serotonin, also known as the “feel good hormone” (Hadhazy, 2010). Because of its complex nervous system, the gut is now often referred to as the second brain. It is closely linked to the central nervous system of the brain (CNS) through the peripheral nervous system (PNS), which leaves the spinal cord and connects to different organs, including the gut. Being aware of this strong connection between the brain and the gut, naturopathic doctors typically target both the gut and the brain when managing mental health conditions such as depression, anxiety, autism, and ADHD.
The connection between the brain and the gut is no longer thought of as unidirectional, top-down control (Stasi et al., 2012). Research actually points to a predominance in the other direction: 90% of the nerve fibers in the vagus nerve (the primary nerve connecting the CNS and the ENS) carry information from the gut to the brain (Nibber et al., 2013)! In addition, the 100 trillion microbes residing in the gut are also involved in neurotransmitter production and therefore influence our mental well-being (Nibber et al., 2013). As a naturopathic doctor, optimizing digestive health is an integral part of almost every treatment plan, with the added bonus of its downstream effects on improving mental health. As well, because of the close link between the gut and input from the nervous and endocrine systems, stress management is an important component in helping to address digestive issues.
Food sensitivities can sensitize nerves in the gut, which in turn can trigger changes in the brain (Nibber et al., 2013). These changes can occur so insidiously that it may be difficult for the patient to pinpoint the culprit. This happened in the case of a 43 year old female who presented to my office with chief concerns of weight gain, fatigue, and generalized aches and pains. She was not on any medication at the time, but had a history of depression. Although she had daily bowel movements, her stools were sometimes loose, and she experienced bloating, which she attributed to excessive hunger and overeating. A careful look through her diet diary and questioning revealed that her diet was high in wheat and glutinous grains, and that her chief concerns had become more pronounced after eating more gluten on a regular basis. Within 5 days of removing gluten from her diet, she found that her stools were more solid, she had more energy, and had increased mental clarity. We continued on a gluten-free diet for 3 weeks, along with botanical medicine to support liver detoxification, and nutraceutical adrenal support due to the long-term stress she was under (confirmed by a Koenisburg adrenal urine stress test). At her next follow-up, food cravings had much improved, and she had lost 12 pounds over the previous 5 weeks. The mental clarity which she had originally experienced persisted while she avoided gluten. Physical injuries which had previously lingered on were now healing faster. If occasionally she ingested gluten, she would experience loose stools, nausea, and headaches. This case exemplifies how certain foods can trigger mood and behavioural changes. While gluten is a common culprit, food sensitivities are highly individual and must be properly evaluated, either through careful elimination and re-introduction, or through blood testing where appropriate.
As well, it is important not to forget about the role of commensal bacteria in the gut in helping achieve better mental health. Studies in mice showed that supplementation with specific probiotic strains, Lactobacillus rhamnosus and Bifidobacterium longus, decreased symptoms of anxiety and depression in these mice, through a vagus nerve-dependent mechanism (Grenham et al., 2011). Studies in mice also show that some probiotics increase resistance to stress by decreasing the release of stress-induced corticosterone (Grenham et al., 2011). Although to date we lack large randomized controlled trials in humans, Messaoudi et al. did find that a specific probiotic combination alleviated psychological distress in otherwise healthy volunteers in a small double blind, placebo-controlled, randomized clinical trial (2011). This may explain in part why strain-specific probiotics can be used to alleviate symptoms of conditions with a strong psychogenic link, such as irritable bowel syndrome.
The link between the gut and the brain is complex and multifactorial. For patients with mood and psychological distress, it is often a relief to find out that what they ingest can impact their mental health, and that it’s not all “in their heads”. Obversely, those presenting with digestive disturbances are often surprised by the alertness and mental clarity they experience once the health of their digestive system is improved.
Our first and second brains are in constant communication, and symptoms such as anxiety, depression, mental fog, and digestive upset are red flags to alert us that something is out of balance. Will you listen?
Grenham, S., Clarke, G., Cryan, J.F., and Dinan, T.G. (2011). Brain-gut-microbiome communication in health and disease, Frontiers in Physiology, December 07; 2(94): 1-15.
Hadhazy, A. (2010). Think Twice: How the Gut’s “Second Brain” Influences Mood and Well-Being, Retrieved August 23, 2013, from the Scientific American website:http://www.scientificamerican.com/article.cfm?id=gut-second-brain.
Messaoudi, M., Lalonde, R., Violle, N., Javelot, H., Desor, D., Nejdi, A. et al. (2011). Assessment of psychotropic-like properties of a probiotic formulation (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175) in rats and human subjects, Br J Nutr, Mar; 105(5): 755-64.
Nibber, T., O’Brien, C., McIntyre, C., Dumas, C.A., Chou, M, Al-Kawally, M. (2013). The Gut-Brain Connection, Advances in Orthomolecular Research, 4(3): 4-7.
Stasi, C., Rosselli, M., Bellini, M., Laffi, G., and Milani, S. (2012). Altered neuro-endocrine-immune pathways in the irritable bowel syndrome: the top-down and the bottom-up model,J Gastroenterol, Nov; 47(11): 1177-85.
Dr. Tamar Ferreira is a Naturopathic Doctor in Brampton, Ontario. Her areas of focus include digestive health, hormone balance, and skin conditions.