What is ADHD?

ADHD stands for Attention Deficit/Hyperactivity disorder. It is the most common neurological condition in children and it is becoming more prevalent¹. ADHD is a cluster of symptoms that fall into three main categories: inattention, hyperactivity and impulsivity. It is usually diagnosed in childhood and can continue through adolescence and adulthood. Some children affected may be hyperactive, have more trouble being patient or be more impulsive with their behaviour than other children their age. What this means is that a child with ADHD can have more difficulty doing well in school or integrating in their community². Approximately 3-7% of children in Canada are affected by ADHD, though the percentage is increasing. In a classroom of 25-30 children, at least one is likely affected³. There is no clear causation pathway to the development of ADHD. The causal factors are likely a combination of genetic and environmental factors as ADHD tends to run in families and also follows environmental distribution patterns.

When a disorder is said to be genetically determined, it is often thought there is nothing one can do to address it because genetic information is fixed at birth. However, there is much we can do with our lifestyles that does in fact make a large impact on the expression of the genetic material we inherit. In other words, things we do during our lives (ie diet, substance use, exercise, exposure to chemicals, etc) can modify the way our DNA behaves.

Due to this reason, as well as the fact that ADHD is also affected by environmental factors, there is great opportunity for the treatment of this disorder ^1,4.

What are Omega 3 fatty acids/oils?

Omega 3 oils are a specific kind of fat that is present in our cell membranes. They are essential because we are not able to make them ourselves, we must obtain them from our diet. Foods high in Omega-3 include fish, vegetable oils, nuts (especially walnuts), flax seeds, flaxseed oil, and leafy vegetables. Not only is Omega 3 an important part of our cell membranes, they also play a role in the cell signaling between cells, they are the building blocks for blood clotting factors and they affect the contraction and relaxation of blood vessel walls. These are the direct effects of Omega 3 fats, but they also have indirect effects through their binding to receptors that regulate gene function, thereby modifying gene expression of our DNA. These are the cellular-level effects of Omega 3 fats. But what does supplementing with the oils do for our overall health? Omega 3 fats have been shown to:

• prevent heart disease and stroke⁵
• treat depression and other mood disorders⁶
• prevent and mediate the progress of type 2 diabetes^{7, 8}
• improve memory and cognitive function⁹
• reduce inflammation¹⁰

Omega 3 fats make a difference in our health. It is helpful to have a good dietary intake, but the benefits and preventive effect of Omega 3 fat is maximized when supplemented above our dietary intake, with dosage according to the presenting concern. There are a few types of Omega 3 fatty acids, with the two most well-known and celebrated being eicosapentaenoic acid (EPA) and docosahexaenoic (DHA). EPA and DHA are mostly found in fish and are often commercially called ‘fish oils’.

Omega 3 supplementation and ADHD

Two facts point to the impact that Omega 3 supplementation may have on ADHD:

• Omega 3 supplementation is effective in other neurological disorders such as cognitive decline, poor memory and depression^6,9
• Children with ADHD have altered fatty acid profiles when compared to unaffected children, suggesting a correlation between poor fatty acid profiles and development of the condition. In other words, children with ADHD have a lower proportion of EPA and DHA in their cell membranes than other children. As such, investigators have begun to look at the use of EPA and DHA on children with attention deficit/hyperactivity disorder¹

In a recent study with high-dose DHA and EPA supplements given to children with ADHD for 8 weeks, there was significant improvement in the biological and psychosocial markers of the condition. The study measured both the fatty acid content of their cell membranes (as a biological marker) and child behaviour (as a psychosocial marker). The starting dose was 30 g/d of combined EPA and DHA and this was adjusted mid-way through the intervention (week 4) based on the changes occurring in the fatty acid profiles.

Fatty acid profiles: the average EPA and DHA levels in the cell membranes of the supplemented children significantly increased by a factor of 9.5 and 2.4 respectively, meaning that their fatty acid profiles responded to the supplementation. With just 8 weeks of intervention their profiles were significantly changed. This allows us to see, biologically, that the supplementation is having an effect at the cellular level and reaching its goal of improving fatty acid profiles.

Behaviour: All categories of the behavioural scale used (ADHD SC-4) were improved by week 8, specifically inattention, hyperactivity, oppositional/defiant behaviour, cognitive problems/inattention and conduct disorder. This allows us to appreciate the psychosocial impact of supplementation.

What does this mean? It means that supplementation with Omega 3 oils at the correct dose has significant impact on the altered biology and behaviors exhibited in ADHD. It also gives us an understanding of how to track the biological impact of the supplementation, allowing us to study correlations between fatty acid profiles and ADHD presentation¹. In short, we can observe the clinical benefit of supplementation at not just a cellular level, but at a ‘life’ level too.

What can you do?

Addressing ADHD in children requires a multi-factorial approach. There is much we can do with lifestyle to modify our genes and therefore modify expression of some conditions. It is an important discovery that supplementing children who have ADHD with high-dose EPA and DHA is a safe and effective way to treat their condition.

How do you take action with this new knowledge to help your children? Talk to your health care provider. Omega 3 supplementation is generally safe, but using it at high doses for medical intervention means it must be monitored. Note that excessive unregulated supplementation affects blood clotting and could dangerously increase bleeding time. Using Omega 3 supplements is an effective way to address ADHD, but proper supplementation dosages and protocol is determined by working with your health care professional/Naturopathic doctor.

References

1. Sorgi et. al., 2007. Effects of an open-label pilot study with high-dose EPA/DHA concentrates on plasma phospholipids and behavior in children with attention deficit hyperactivity disorder. Nutrition Journal 2007. 6. 16. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1971271/.
2. NIH, National Institute of Mental Health, Attention Deficit Hyperactivity Disorder. http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder-easy-to-read/index.shtml
3. Mental Health Canada, http://www.mentalhealthcanada.com/ConditionsandDisordersDetail.asp?lang%20=e&category=60
4. Burgess et. al., Long-chain polyunsaturated fatty acids in children with attention-deficit hyperactivity disorder. American Journal of Clinical Nutrition.2000 Jan;71(1 Suppl):327S-30S. http://www.ncbi.nlm.nih.gov/pubmed/10617991
5. Harvard School of Public Health, Omega-3 Fatty Acids: An Essential Contribution http://www.hsph.harvard.edu/nutritionsource/omega-3-fats/
6. Mocking et. al., Meta-analysis and meta-regression of omega-3 polyunsaturated fatty acid supplementation for major depressive disorder. Transl Psychiatry.2016 Mar 15;6:e756. doi: 10.1038/tp.2016.29. http://www.ncbi.nlm.nih.gov/pubmed/26978738
7. Kim et. al., Intake of fish and long-chainomega-3 polyunsaturated fatty acids and incidence of metabolic syndrome among American young adults: a 25-year follow-up study. European Journal of Nutrition. 2016 Jan 27 http://www.ncbi.nlm.nih.gov/pubmed/26816031
8. Tørris et. al., Fish consumption and its possible preventive role on the development and prevalence of metabolic syndrome – a systematic review. Diabetol Metab Syndr.2014 Oct 17;6(1):112. doi: 10.1186/1758-5996-6-112. eCollection 2014. http://www.ncbi.nlm.nih.gov/pubmed/25352919
9. Külzow et. al., Impact of Omega-3 Fatty Acid Supplementation on Memory Functions in Healthy Older Adults. Journal of Alzheimers Disease.2016 Feb 10;51(3):713-25. doi: 10.3233/JAD-150886. http://www.ncbi.nlm.nih.gov/pubmed/26890759
10. Siriwardhana et. al., Health benefits of n-3 polyunsaturatedfatty acids: eicosapentaenoic acid and docosahexaenoic acid.Adv Food Nutr Res. 2012;65:211-22. doi: 10.1016/B978-0-12-416003-3.00013-5 http://www.ncbi.nlm.nih.gov/pubmed/22361189

Do You Crave Ice a lot?

It’s approaching the warmest days of the year and hot drinks are making the transition to iced drinks. We may all want some cooler beverages, but have you noticed you are craving ice much more than usual? Are you chewing ice all the time? Research shows that this is possibly driven by an underlying health condition related to blood iron stores. While not dangerous itself, craving ice could be the first sign of iron-deficiency anemia which can be serious if left untreated. Treating this underlying condition is important, so becoming aware of a strong craving for ice may help you get the treatment you need.

The Connection between Ice and Iron

This ice craving is more than liking ice in your beverages. It is defined as, “an excessive compulsion for chewing ice or consuming iced drinks” and when it reaches this level, it is termed pagophagia¹. It is most commonly seen in pregnant women and children, though it can be seen at any age and in any gender². It has also commonly been observed after patients undergo certain types of gastric bypass surgery^3,4. Each of these groups who most commonly exhibit pagophagia are known to either have an increased need for iron or a difficulty in absorbing it. This suggests a mysterious link between ice craving and iron.

Since initial observations of this phenomenon, many case studies have pointed to the connection between iron-deficiency anemia and eating ice². The connection is not fully understood, but theories include the relief of inflammation in the mouth and throat caused by iron-deficiency anemia, the perturbation of appetite centers in the brainstem from low blood iron levels, and tissue enzyme deficiencies from missing iron as a cofactor^4,5. Although the connection may not be perfectly clear, strong evidence shows that excessive ice cravings are resolved when patients are treated for iron-deficiency anemia^2,5.

Iron-deficiency anemia

Anemia is simply the condition of not having enough red blood cells. The most prevalent form is iron-deficiency anemia which is caused by insufficient free and stored iron in the body². A key component of healthy red blood cells is hemoglobin, a protein responsible for the transport of oxygen from the lungs to tissues in the body. Iron is required to make hemoglobin, and so a lack of iron will interfere with the body’s ability to make enough hemoglobin and healthy red blood cells for oxygen delivery⁶.

The reasons why someone may not have enough iron to make red blood cells include:

• The body is losing more blood cells and iron than it can replace with diet (ex: chronic bleeding disorders or other excessive blood loss due to chronic heavy periods).
• The body is not absorbing enough iron, either because of poor iron absorption (ex: gastric bypass surgery) or by low dietary intake (ex: prolonged improper diet).
• The body requires more than normal amounts of iron and is not getting enough through regular diet (ex: childhood and pregnancy).

Iron deficiency anemia is a significant health condition that can affect a person’s ability to function. Other symptoms include fatigue, low motivation, mood disturbances, shortness of breath, weakness, restless legs, dizziness, a sore tongue, headaches, hair loss, brittle nails, pale appearance and impaired immune function^{6,7, 8}. A simple way check for potential anemia is to look at the inside of your bottom eyelid: is it very pale? If it is, this could be an indication you need natural iron therapy. Check with your health care provider.

It is important to note that there are two types of iron: heme and non-heme. The difference is mainly that heme iron is found in animal products while non-heme is found in leafy greens and other plant sources. About 15-30% of heme iron from animals is absorbed in the human gut, depending on your current iron stores. Meaning, if you are low in iron, you will absorb up to almost a third of what you take in. Sound like a low absorption rate? Unfortunately non-heme iron is even lower, being absorbed only at 2-20% of what is taken in. This absorption rate is less affected by what your stores are like, and more by what other foods and beverages you have in your system at the same time (point 3 below has more information on what affects iron absorption)⁸.

How to Improve Iron Levels Naturally

The good news is that iron-deficiency anemia is treatable. Using a range of therapies, blood iron levels and body iron stores can be raised to healthy levels and restore proper cellular functioning, oxygen delivery and energy levels. A good treatment plan must also investigate and address the cause of low iron—poor absorption, poor diet, excessive bleeding, etc.

1. One of the easiest and most important therapy approaches is through diet. Start by increasing green leafy vegetables in your diet, also red cabbage, parsley, beets, alfalfa, watercress, wheat grass, spinach, cucumbers, tomato juice, fish, coconuts, eggs, black strap molasses, black cherry and blackberry juice. If you are not a strict vegan or vegetarian, consider consuming organic red meat especially when you know you are losing blood (for example, during menses).
2. An important addition for iron therapy is supplementation. There are many different forms of supplements and some are better absorbed than others so it is advised to speak with a naturopathic doctor to determine the best one for you.
3. Pay attention to other things that may be affecting your iron levels. Some tips⁹:

• Taking iron with vitamin C helps absorption, speeding up results for iron therapy
• Taking digestive enzymes may help you absorb better as well, especially if you have problems digesting dairy and protein properly
• Taking antacid tablets with calcium can interfere with iron absorption and lead to iron deficiency
• Coffee, tea and wine contain polyphenols can also reduce the absorption of iron in the gut
• Low folic acid and B12 levels can look like iron-deficiency anemia, so it might be necessary for you to also supplement with these nutrients.
• Low stomach acid levels may contribute to low iron by decreasing your ability to digest foods properly. You may want to check with your health care provider.
• Minerals (calcium, zinc and copper) can affect the absorption of iron so it is best to take your iron supplement with Vitamin C and away from other supplements that contain minerals
• Phytic acid found in grains, leafy greens, soy and other legumes can inhibit iron absorption
• Last but not least, parasites in the body can also drastically reduce iron levels. If there is any chance you have picked up a parasite, its eradication is essential to reversing iron-deficiency anemia.

These pointers are here to help you begin to think about how many aspects of your health are connected: how diet, supplementation, and other factors can affect iron levels and therefore cause you to crave ice or have other symptoms of anemia. Be empowered and learn about your body and your habits, but also be sure to discuss with a trusted health care practitioner how you can address this. Iron-deficiency anemia is indicated by many symptoms – from eating ice to brittle nails – but once it is caught, it can be treated to help you move towards a more energetic and healthy way of living.

References

1. Parry-Jones, B, 1993. Pagophagia, or compulsive ice consumption: a historical perspective. Psychological Medicine(Psychol Med) 22 (3): 561–71. doi:1017/s0033291700038022.PMID 1410082.
2. Youssef, 2005. Craving for Ice and Iron-deficiency Anemia, a case series from Oman. Pediatric Hematology and Oncology, 22: 127–131, 2005 online DOI: 10.1080/08880010590896486
3. Kushner and Retelny, 2005. Emergence of Pica (Ingestion of Non-food Substances) Accompanying Iron Deficiency Anemia after Gastric Bypass Surgery. Obesity surgery. November 2005, Volume 15, Issue 10, pp 1491-1495

4. O’Connor 2010. http://www.nytimes.com/2010/06/22/health/22real.html?ref=health&version=meter+at+1&module=meter-Links&pgtype=Blogs&contentId=&mediaId=%25%25ADID%25%25&referrer=&priority=true&action=click&contentCollection=meter-links-click
5. Reynolds, 1968. Pagophagia and Iron Deficiency Anemia. Annals of Internal Medcine. 1968;69(3):435-440. doi:10.7326/0003-4819-69-3-435
6. National Library of Medicine. Iron Deficiency Anemia. https://www.nlm.nih.gov/medlineplus/ency/article/000584.htm
7. Merck Manual Online for Professionals. Iron Deficiency Anemia.http://www.merckmanuals.com/professional/hematology-and-oncology/anemias-caused-by-deficient-erythropoiesis/iron-deficiency-anemia
8. Davis, 2013. Considering an Iron Supplement? Be Informed! http://anitadavisnd.com/considering-an-iron-supplement-be-informed/

Williams, 2015. Iron Deficiency and Natural Treatments for Anemia. http://www.drdavidwilliams.com/iron-deficiency-and-natural-anemia-treatment/

What is Dementia?

Dementia is an umbrella term for a set of symptoms that are caused by disorders affecting the brain. Symptoms may include memory loss, and/or difficulties with thinking, problem solving, or language and can lead to changes in mood or behaviour. Alzheimer’s disease is the most common disease that causes dementia but there are other causes, including vascular changes, thyroid gland problems, head trauma, depression, vitamin deficiency, Parkinson’s disease, chronic infections, and medications.¹

Dementia can be progressive if the cause is not treatable, which means the symptoms will gradually worsen as more brain cells become damaged. However, some causes are treatable and dementia is reversible, for example if it is caused by vitamin deficiencies, medications, or thyroid problems. If you are seeing signs of dementia it is important to see a health care practitioner to determine and treat the root cause. 

Only a part of dementia can be attributed to genetic predisposition. Much more is due to environmental, physiological, and lifestyle factors. If you or a loved one is worried about developing dementia, the good news is that you can do a lot of truly preventative work now to keep your brain healthy.

There are both modifiable and non-modifiable risk factors for dementia. Here we will focus on the ones we can do something about! We have developed 10 strategies for helping prevent the development of dementia by working on most of the following modifiable risk factors:²

• Poor diet & vitamin deficiencies
• Use of medication that contributes to dementia
• Impaired thyroid function
• Cardiovascular risks (high cholesterol, high blood pressure, diabetes)
• Smoking
• Low physical activity
• Alcohol use
• Head injuries

10 Ways to Help Reduce the Risk of Dementia

1. Minimize use of anticholinergic medication: Many prescription and over-the-counter sleep aids, heart medication, antidepressants, and allergy medicines (among others) have moderate to strong anticholinergic activity in the body. A recent large, long-term study has shown that cumulative high-dose anticholinergic use is associated with higher risk of developing dementia. Efforts are being made to help health care providers educate patients about which medications have this effect, how much is dangerous, and how to reduce their use. Don’t stop taking these medications right away if you are, but be aware and be sure to have a conversation with your doctor about how to limit their usage or change medications^3,4 Follow link to see list of common medications with anticholinergic properties: http://www.virginiageriatrics.org/consult/medications/medsList.html
2. Take vitamin D: Both animal and pre-clinical human studies have shown a correlation between low levels of vitamin D and cognitive decline leading to symptoms of dementia. Supplementing animals with Vitamin D is protective against processes that lead to dementia and Alzheimer’s disease. More large-scale human trials are on the way, but all evidence is pointing to the protective benefit of Vitamin D. Getting out in the sun may not be enough, especially in winter months; taking a supplement is the most effective way to get optimum vitamin D levels for the prevention of dementia.⁵
3. Take fish oil: Decosahexaenoic acid (DHA) is one of the main fats in fish oil. Lower DHA levels are associated with increased cognitive impairment and poorer scores on memory tests in older adults. Studies show that supplementing with fish oils is most effective at the early stages of dementia or even before showing any signs to help prevention. To make sure you are getting the brain-boosting effects, take enough fish oil (commonly a combination of EPA and DHA) to get at least 1000mg of DHA per day.^6,7 As always, talk with your doctor before starting fish oil as incorrect supplementation can have unwanted effects.
4. Take a B complex vitamin: B vitamins are cofactors in many cellular processes. In this context, they are very helpful in lowering levels of a molecule called homocysteine (HC)- especially vitamin B12, B6 and folate. HC is known to damage the vascular system and having a high level can contribute to risk of heart disease, stroke, or other vascular problems leading to age-related cognitive decline. Something as simple as taking a B complex that includes 500mcg of B12 (methylcobalamin) can effectively lower HC and reduce its damaging effect on the body.⁸
5. Be physically active: Regularly getting your blood moving and your heart pumping is one of the most effective ways to strengthen your vascular system. This is preventative medicine for nearly all chronic health concerns! It doesn’t need to be an intense workout regime; thirty minutes a day of moderate activity like walking, biking, or gardening is enough to see the health benefits of exercise. Increase the benefits even more by doing your exercise outside. Connecting with nature is inherently healing and has been shown to reduce blood pressure and weight faster than exercise indoors.^8,9
6. Challenge your brain by trying something new, doing crosswords, word puzzles, or learning a new language: Sound incredible? This really is preventative. Studies show that being bilingual, for example, delays the onset of symptoms of dementia by almost 5 years compared to elderly adults who speak only one language¹⁰. Another study has shown that doing regular crossword puzzles can delay the onset of memory decline by 2.5 years.¹¹
7. Control alcohol intake and quit smoking: The oxidative damage done by smoking and excessive alcohol intake is almost unparalleled, and is what leads to many chronic disease processes. The evidence is strong that current daily smokers are at a 45% higher risk of developing Alzheimer’s disease when compared to non-smokers or former smokers. When looking at risk due to alcohol consumption, people who drink moderate amounts of alcohol have the lowest risk of developing dementia. Those who don’t drink any alcohol at all have a slightly higher risk, and those who drink excessively have the highest risk. These results can be explained by the slight antioxidant power of moderate alcohol intake, mostly from red wine. Moderate drinking is generally considered no more than one drink per day.²
8. Protect against head injuries for your whole life: Wear a helmet on a bike, no ifs, ands, or buts about it. If you ever suffer a concussion, ensure to not further damage your brain while it is in an already-aggravated state. Be extra careful to protect it and avoid successive concussions.²
9. Stay connected socially and interact with others regularly: Having a social network that is reliable is one of the best defenders against many health conditions. Regularly interacting with others can protect against the adverse effects of isolation and loneliness. Combine this with physical activity or nature and get extra benefit!²
10. Track your numbers: keep your blood pressure, cholesterol, fasting blood glucose, and weight within recommended ranges : All of these measures of cardiovascular and metabolic health are some of the most important predictors of dementia. These are big categories that affect your risk of not just dementia, but heart disease, stroke, and other diseases, so it really is in your best interest to control these parameters of your health. Your metabolism is a part of this too- adults who develop type-2 diabetes in mid life are twice as likely to develop Alzheimer’s as those who don’t. Tackle these with the help of your health care provider and natural approaches.²

These are some, but not all, of the ways you can help protect yourself and your brain from age-related decline and dementia. Be sure to rule out other health concerns like thyroid dysfunction or depression with a health care provider. While you should consider these suggestions, don’t forget that just having a regular healthy diet with fish, nuts, seeds and leafy greens is very helpful for preventing dementia and for so much more. What’s stopping you from taking care of yourself now so you and your beloved brain can live to a healthy old age? Give yourself some self-care and pick up these habits.
References

1. Alzheimer’s Society of Canada. Risk factors for Dementia. http://www.alzheimer.ca/en/About-dementia/Alzheimer-s-disease/Risk-factors
2. Alzheimer’s Society of Canada. What is Dementia? http://www.alzheimer.ca/en/About-dementia/What-is-dementia
3. Gray et. al., 2015. Cumulative Use of Strong Anticholinergics and Incident Dementia, A Prospective Cohort Study. JAMA Internal Medicine, 2015 175:(3) http://archinte.jamanetwork.com/article.aspx?articleid=2091745
4. CNN online. April 18, 2016. Author Ben Tinker. Common over-the-counter drugs can hurt your brainhttp://www.cnn.com/2016/04/18/health/otc-anticholinergic-drugs-dementia/
5.  Landel et. al., 2016. Vitamin D, Cognition, and Alzheimer’s Disease: The Therapeutic Benefit is in the D-Tails.J Alzheimers Dis. 2016 May 11. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/27176073
6.  Yurko-Mauro, 2010. Cognitive and cardiovascular benefits of docosahexaenoic acid in aging and cognitive decline. Curr Alzheimer Res. 2010 May;7(3):190-6.http://www.ncbi.nlm.nih.gov/pubmed/20088810  
7. Hashimoto et. al., 2016. Beneficial effects of dietary docosahexaenoic acid intervention on cognitive function and mental health of the oldest elderly in Japanese care facilities and nursing homes. Geriatr Gerontol Int. 2016 Jan 28. doi: 10.1111/ggi.12691. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/26822516

8. Food For the Brain, Action Plan for Dementia and Alzheimer’s, http://www.foodforthebrain.org/nutrition-solutions/dementia-and-alzheimer%E2%80%99s-disease/action-plan-for-dementia-alzheimer%E2%80%99s.aspx
9. Logan and Selhub 2012.Your Brain on Nature. https://www.amazon.ca/Your-Brain-Nature-Eva-Selhub/dp/1443428086
10. Alladi et. al., 2013. Bilingualism delays age at onset of dementia, independent of education and immigration status.Journal of Neurology 2013 vol. 81 no.22
    https://www.newscientist.com/article/dn24537-learn-another-language-to-delay-three-dementias/
11. Pillai et.al., 2011. Association of crossword puzzle participation with memory decline in persons who develop dementia.J Int Neuropsychol Soc.2011 Nov;17(6):1006-13. http://www.ncbi.nlm.nih.gov/pubmed/22040899

 

By Dr. Candace Haarsma

What is SIBO (‘see-bo’)?

SIBO, or Small Intestinal Bacterial Overgrowth, is a chronic bacterial overgrowth of the small intestine with bacteria that normally live in the gastrointestinal tract but have abnormally overgrown in a location not meant for so many bacteria.

What are the symptoms of SIBO?

The main symptoms of SIBO are those similar to irritable bowel syndrome (IBS), including:

• abdominal bloating, pain and cramping
• excessive gas/flatulence
• constipation, loose stool or alternating bouts of loose stool and constipation
• nausea
• heartburn and/or regurgitation of food
• slow digestion and sensation of fullness

Causes

The primary cause of SIBO is thought to be a dysfunctional migrating motor complex (MMC). A migrating what…? The MMC is like a house keeping process that sweeps remaining debris through the digestive tract in a cyclic, repeating pattern approximately every 3 hours. With a functional MMC, food waste and, importantly, bacteria are pushed from the small intestine into the large intestine and towards the rectum.

Secondary causes and compounding factors include low stomach acid, bile insufficiency, pancreatic enzyme insufficiency, intestinal strictures, ileocecal valve disorders and small intestinal inflammation and/or damage.

Associated conditions

Many conditions are associated with SIBO. These can include:

• GERD/heartburn
• iron deficiency
• vitamin B12 deficiency
• rosacea
• eczema
• acne
• gastroparesis
• gallstones
• intestinal permeability

What are the concerns with SIBO, besides symptoms?

Our normal digestion and absorption of food is disrupted, and the bacteria are associated with damage to the lining of the small intestine.

Problems in SIBO

• nutrient deficiency, such as vitamin B12 and iron
• accumulation of gas produced by the bacteria after eating our food contributing to symptoms (bloating, pain, belching, flatulence)
• decreased normal fat absorption through bile deconjugation, which can cause deficiencies of vitamins A and D and fatty stools
• increased excretion of acids by the bacteria which can cause cognitive and neurological symptoms
• food sensitivities

Testing

There is a non-invasive test frequently used in SIBO-based research, which is a breath test measuring amounts of certain gases produced by the bacteria over a three hour time period. This test is available at our clinic.

Treatment goals

The goals of treatment for SIBO include treating the overgrowth and recovery and prevention (which includes correcting the underlying cause, providing nutritional support, healing the intestinal lining and addressing any compounding factors).

References

About SIBO and Treatment. (n.d.). Retrieved July 05, 2016, from http://www.siboinfo.com/about-sibo.html

Hill, A., Dr. (n.d.). Identifying correlations between small intestinal bacterial overgrowth and micronutrients. Lecture.

Khangura, P., ND, & Saunders, L., ND. (2016, February/March). Superseding SIBO. Lectures.

The Mood Disorders Society of Canada put out a startling statistic in 2009: 1 in 5 Canadians will experience a mental illness in their lifetime¹, including depression, mood disorder, anxiety disorder, bipolar disorder, schizophrenia, attention deficit hyperactive disorders and dementia (with anxiety and depression being the most common by far). If 20% of our population will experience such an event, it is very likely you or someone you know is, has been, or will be affected by mental illness. Rates have been climbing in Canada steadily for several decades and are expected to continue increasing². Within a generation, it is estimated that more than 8.9 million Canadians will be living with a mental illness.

If you or someone you know struggles with mood regulation, anxiety, bipolar disorder, or depressive episodes, chances are you’ve heard of the many options available for treatment—everything from pharmaceuticals to nutraceuticals to acupuncture. There are so many approaches to mood support it can be hard to know what’s right for you.

Nearly 10% of our country’s population is using some form of prescription antidepressant medication³. This first-line conventional treatment is not cheap—a conservative estimate of the cost of mental illness in Canada in 2011 was $42.3 billion in direct costs and $6.3 billion in indirect costs². With so many Canadians living with mental illness, together with such high treatment costs, it’s a wonder that one of the most effective, safe and inexpensive tools for mood regulation is so underused as a prescriptive treatment for mental illness: exercise.

When I lecture and speak to patients, I share this quote: ‘Pharmaceuticals (anti-depressants) are the most over utilized prescription for depression and anxiety and exercise is the most underutilized”. I go on to explain that I understand how difficult it is when you are in the pit of depression & despair to exercise. I also share that there have been times that THAT is all that I have “accomplished” in a day. The struggle to get myself out the door has been agony at times. It has taken me several hours – 2, 4, 6, 8 or 10 hours at times – to move from my bedroom to the door. When I am depressed, the battle between the side of me that wants to get well and the side of me that is stuck in depression and defeat can be paralyzing and it can take hours to muster up the courage to do all the steps required to get me out the door:

1. get out of bed
2. get dressed
3. brush my teeth or hair if I am not able to take a shower
4. get to the door
5. put my shoes on
6. open the door
7. take one step
8. take another step
9. take another step
10. repeat steps 8&9 for a minimum of 30 minutes

Sometimes I have sat at the door for over an hour just struggling with the contemplation and action of putting my shoes on. But, I can tell you this – as much as I didn’t want to go – I have never once, come back from exercising outside feeling worse than when I began. Never. Once. The endorphin benefit may be short-lived and not sustain me to the next morning, but I believe that there is a cumulative effect of exercise and if repeated enough times on a weekly or daily basis, that you can’t help but feel better.

It seems almost too easy to think that something so simple could make a real impact on mental illness, but strong evidence speaks loudly. Studies on the neurobiochemistry of mental illness show exercise is an effective treatment for mental illness.

What kind of exercise?

Aerobic, resistance and strength training, recreational, and “green exercise”

Many studies investigating the beneficial effect of exercise on mental health are done on aerobic exercise, generally 60-300 min/week of aerobic activity: jogging, cycling and other such high-intensity activities. Research reviews on aerobic exercise show significant reductions in depression and anxiety scores, improved cognition, and improved self-perception; features central to many mental health improvements^4-7. A 2016 meta-analysis on regular aerobic exercise as a treatment for depression shows it is statistically equally as effective as treatment with antidepressants without any of the cost or adverse effects of such medication^8,9. When exercise is used in combination with medication, response is better than either treatment alone. Several studies have also shown aerobic exercise to be effective at reducing psychiatric symptoms in individuals diagnosed with schizophrenia, bipolar disorder, attention deficit hyperactive disorder, and obsessive-compulsive disorder^10-13.

Fortunately, it’s not just running and aerobics that improve mental health. Studies have also shown the psychological benefit of regular strength and resistance training without aerobic fitness improvement^14,15. Regular weight lifting, playing sports and other types of active exercise can improve mood and decrease anxiety and depression scores as well as rigorous high-intensity running¹⁵. These improvements to mental wellbeing can begin to be seen with as little as 20 minutes, three to five times a week of brisk walking, tennis, dancing, weight training or anything else that gets your heart rate up or your muscles pumping.

A review of population-wide studies in the U.S. and Canada tells another interesting story about what type of exercise is best for the brain—it’s more beneficial when it’s recreational. Compiling data and comparing between groups of people who use similar amounts of energy in household chores versus recreational exercise shows a greater psychological benefit in the group engaging in recreational exercise¹⁶.

Finally, to get the most out of exercise, take it outside. It is known that both physical activity and exposure to nature separately have positive effects on physical and mental health. Research is now showing they have a synergistic effect on parameters of mental health when experienced together. Their combination is being called “green exercise” and is proven to be more beneficial than exercise without exposure to nature¹⁷. A 2010 study shows that the perceived greenness of an exercise area is proportionally correlated with reductions in anxiety after exercising there¹⁸. In other words, the greener the environment of your run, the less anxious you will feel after you’ve done it. Another study by Pretty et. al. (2005) reports significantly improved blood pressure, mood and self-esteem after running in pleasant natural environments versus control environments (running on a treadmill without a screen) or in unpleasant environments¹⁹. A meta-analysis shows that one of the populations most affected by the presence of nature during exercise are those suffering from mental health concerns¹⁷.

Who benefits from exercise?

The significant, measurable psychological effects described above are seen in both clinical populations (those with a diagnosed anxious or depressive disorder) and in healthy populations, pointing out that exercise benefits both those with mental illness and those wanting to prevent it²⁰. This effect is seen in all ages, shown by studies in ages from adolescents to the elderly^7,21.It is interesting to note that the positive effect of exercise on parameters of mental health is independent of economic status, age, gender, and physical health status. This means that a person can start wherever they are—fit or not, young or old, and still feel the psychological benefits of exercise¹⁶.

How it works to support mental health

Various mechanisms are responsible for the mental health benefits of exercise. The first and perhaps most obvious physiological changes that happen during exercise are increased heart and breath rate. This allows for higher oxygen delivery to the whole body, including the brain²². Increased cerebral vascular flow sends nutrients, energy, and other benefits to brain cells to support their function during the strain of physical exertion. It even changes patterns of neuronal activity post-exercise. For example, changing blood flow and brain metabolism through exercise has been shown to alter symptomatic neural response in adults and children with bipolar disorder. Several studies are suggesting physical activity as a new early treatment of this condition^13,23.

Increased blood flow to the brain is also serving to activate metabolic pathways that replenish depleted neurotransmitters; depleted neurotransmitters being a state common to many mental health disorders. Dr. Richard Maddock, a professor in the Department of Psychiatry and Behavioral Sciences at the University of California Davis, explains, “From a metabolic standpoint, vigorous exercise is the most energetically demanding activity the brain encounters, much more intense than calculus or chess, and one of the things it’s doing [with all the energy] is making more neurotransmitters.”²⁴. This is directly beneficial to many mental health concerns. A major depressive episode, for example, is often characterized by depletion of glutamate and GABA. Both of these neurotransmitters have their pathways turned on by exercise²⁴.

Exercise affects not only blood flow and brain metabolism, it also physically changes the brain. Olson et. al. (2006) show that regular aerobic exercise creates new neurons and increases mass in the hippocampus, a part of the brain responsible for memory and thinking²⁵. In addition, when cells in the body are stressed by exercise, they release growth factors in the brain: improving the health of existing brain cells, growing new blood vessels in the brain, and even improving the survival of new brain cells²⁶. Deslandes et. al., (2009) discuss the protective effect of exercise against changes in the physical brain associated with aging, concluding that exercise is an essential part of long-term optimal brain functioning, ultimately decreasing the chances of developing age-related cognitive decline²⁷.

What you can do

You can start today. It doesn’t take much and you don’t have to become fit overnight. But committing to a goal of regular exercise to get your heart rate up or your muscles engaged can be enough to support your mental health for the long term. If possible, get even more benefit by exercising outside in a green environment. Going for a walk three times a week is enough to begin to feel a change without any side effects or costs to you. If it helps, find a group of like-minded people and get moving together. This not only improves your mental health in the ways discussed in this article but the sense of community, companionship and friendship also has a beneficial impact on mood. I credit tennis to lifting a depression that had been weighing me down for several months in 2008. A friend asked me to play and we started playing a few nights a week. I was now engaging in a social activity with a friend, getting outside in the fresh air, getting sunlight/Vit D and was stimulating my appetite because of the exercise. After 2 months of this, I was no longer depressed!

Supporting mental health is an increasingly important goal for our personal future and for our future generations. Exercise is an inexpensive, effective, and safe treatment option and needs to be included as part of a comprehensive wellness treatment plan for mental health concerns. If we as a nation participate and engage in exercising our bodies, we can work to manage the mental health concerns of our present and future society.

References

1. Quick Facts on Mental Illness and Addictions in Canada (3^rd Edition). (2009). Mood Disorders Society of Canada. http://www.mooddisorderscanada.ca/page/quick-facts
2. Smetanin, P., Stiff, D., Briante, C., Adair, C.E., Ahmad, S. and Khan, M. The Life and Economic Impact of Major Mental Illnesses in Canada: 2011 to 2041. RiskAnalytica, on behalf of the Mental Health Commission of Canada 2011. http://stg.mentalhealthcommission.ca/English/system/files/private/document/MHCC_Report_Base_Case_FINAL_ENG_0.pdf
3. Statistics / health at a glance / 2013 /. (2013). Organization for Economic Cooperation and Development (OECD) Retrieved July 14, 2016, from http://www.oecd-ilibrary.org/sites/health_glance-2013-en/04/10/g4-10-04.html?contentType=&itemId=/content/chapter/health_glance-2013-41-en&containerItemId=/content/serial/19991312&accessItemIds=/content/book/health_glance-2013-en&mimeType=text/html&_csp_=2f6481becc176514dc3acbdcffc1daaa
4. Craft, L. L., & Landers, D. M. (1998). The effect of exercise on clinical depression and depression resulting from mental illness: A meta-analysis.Journal of Sport and Exercise Psychology, 20, 339-357.
5. Petruzzello, S. J., Landers, D. M., Hatfield, B. D., Kubitz, K. A., & Salazar, W. (1991). A meta-analysis on the anxiety-reducing effects of acute and chronic exercise. Sports medicine, 11(3), 143-182.
6. Den Heijer, A. E., Groen, Y., Tucha, L., Fuermaier, A. B., Koerts, J., Lange, K. W., … & Tucha, O. Sweat it out? The effects of physical exercise on cognition and behavior in children and adults with ADHD: a systematic literature review. Journal of Neural Transmission, 1-24.
7. Carter, T., Morres, I. D., Meade, O., & Callaghan, P. (2016). The Effect of Exercise on Depressive Symptoms in Adolescents: A Systematic Review and Meta-Analysis. Journal of the American Academy of Child & Adolescent Psychiatry.
8. Kvam, S., Kleppe, C. L., Nordhus, I. H., & Hovland, A. (2016). Exercise as a treatment for depression: A meta-analysis. Journal of affective disorders,202, 67-86.
9. Mead, G. E., Morley, W., Campbell, P., Greig, C. A., McMurdo, M., & Lawlor, D. A. (2009). Exercise for depression. The Cochrane Library.
10. Beebe, L. H., Tian, L., Morris, N., Goodwin, A., Allen, S. S., & Kuldau, J. (2005). Effects of exercise on mental and physical health parameters of persons with schizophrenia. Issues in mental health nursing, 26(6), 661-676.
11. Abrantes, A. M., Strong, D. R., Cohn, A., Cameron, A. Y., Greenberg, B. D., Mancebo, M. C., & Brown, R. A. (2009). Acute changes in obsessions and compulsions following moderate-intensity aerobic exercise among patients with obsessive-compulsive disorder. Journal of anxiety disorders, 23(7), 923-927.
12. Callaghan, P. (2004). Exercise: a neglected intervention in mental health care?. Journal of psychiatric and mental health nursing, 11(4), 476-483.
13. Souza de Sa Filho, A., Marcos de Souza Moura, A., Khede Lamego, M., Barbosa Ferreira Rocha, N., Paes, F., Cristina Oliveira, A., … & Wegner, M. (2015). Potential therapeutic effects of physical exercise for bipolar disorder. CNS & Neurological Disorders-Drug Targets (Formerly Current Drug Targets-CNS & Neurological Disorders), 14(10), 1255-1259.
14. Martinsen, E. W., Hoffart, A., & Solberg, Ø. (1989). Comparing aerobic with nonaerobic forms of exercise in the treatment of clinical depression: a randomized trial. Comprehensive psychiatry,30(4), 324-331.
15. Stathopoulou, G., Powers, M. B., Berry, A. C., Smits, J. A., & Otto, M. W. (2006). Exercise interventions for mental health: a quantitative and qualitative review. Clinical Psychology: Science and Practice, 13(2), 179-193.
16. Stephens, T. (1988). Physical activity and mental health in the United States and Canada: evidence from four population surveys. Preventive medicine,17(1), 35-47.
17. Barton, J., & Pretty, J. (2010). What is the best dose of nature and green exercise for improving mental health? A multi-study analysis.Environmental science & technology, 44(10), 3947-3955.
18. Mackay, G. J., & Neill, J. T. (2010). The effect of “green exercise” on state anxiety and the role of exercise duration, intensity, and greenness: A quasi-experimental study. Psychology of Sport and Exercise, 11(3), 238-245.
19. Pretty, J., Peacock, J., Sellens, M., & Griffin, M. (2005). The mental and physical health outcomes of green exercise. International journal of environmental health research, 15(5), 319-337.
20. De Moor, M. H. M., Beem, A. L., Stubbe, J. H., Boomsma, D. I., & De Geus, E. J. C. (2006). Regular exercise, anxiety, depression and personality: a population-based study. Preventive medicine, 42(4), 273-279.
21. Lisanne, F., Bolandzadeh, N., Nagamatsu, L. S., Hsu, C. L., Davis, J. C., Miran-Khan, K., & Liu-Ambrose, T. (2015). Aerobic Exercise Increases Hippocampal Volume in Older Women with Probable Mild Cognitive Impairment: A 6-Month Randomized Controlled Trial.British journal of sports medicine, 49(4), 248.
22. Querido, J. S., & Sheel, A. W. (2007). Regulation of cerebral blood flow during exercise. Sports Medicine, 37(9), 765-782.
23. Metcalfe, A. W. S., MacIntosh, B. J., Scavone, A., Ou, X., Korczak, D., & Goldstein, B. I. (2016). Effects of acute aerobic exercise on neural correlates of attention and inhibition in adolescents with bipolar disorder. Translational psychiatry, 6(5), e814.
24. Wood, J. (2016, February 28). Hard exercise can boost brain chemicals sapped by depression | Psych central news. Retrieved July 14, 2016, from Psych Central, http://psychcentral.com/news/2016/02/28/people-who-exercise-have-better-mental-fitness/99703.html
25. Olson, A. K., Eadie, B. D., Ernst, C., & Christie, B. R. (2006). Environmental enrichment and voluntary exercise massively increase neurogenesis in the adult hippocampus via dissociable pathways. Hippocampus, 16(3), 250-260.
26. Godman, H. (2014, April 9). Regular exercise changes the brain to improve memory, thinking skills – Harvard health Blog. Retrieved July 14, 2016, from Harvard Health, http://www.health.harvard.edu/blog/regular-exercise-changes-brain-improve-memory-thinking-skills-201404097110
27. Deslandes, A., Moraes, H., Ferreira, C., Veiga, H., Silveira, H., Mouta, R., … & Laks, J. (2009). Exercise and mental health: many reasons to move. Neuropsychobiology, 59(4), 191-198.
28. Sparks, A. (2015). Lena Dunham on exercise: “It Ain’t about the Ass.” Retrieved July 14, 2016, from Psych Central Blogs, http://blogs.psychcentral.com/your-mind/2015/04/lena-dunham-on-exercise-it-aint-about-the-ass/

 

 

7 Birth Control Options Besides “The Pill” by Dr. Christina Bjorndal and Lachlan Crawford

The combination oral contraceptive pill (OCP) is typically a combination of estrogen and progestin taken orally to prevent female fertility and pregnancy. It was first introduced in 1960 and since then it has undergone many modifications and has been used by millions of women worldwide. Of Canadian women who use contraception, 32% use the OCP as their method of birth control¹. It is one of the most used forms of contraception in Canada, but more and more women are looking to alternatives to oral hormonal contraceptive methods. What follows is an overview of some of the most common alternatives to “the pill”. Birth control is a personal choice and it is your right to be informed of the options available for safe and effective contraception.

The Copper IUD (ParaGuard)

A copper IUD is a small medical device that is inserted into the uterus and remains there as an effective form of contraception for 5 to 12 years². This IUD releases copper ions into the uterine cavity that interferes with sperm so that they are no longer viable to travel or to fertilize an egg, although the mechanism for this is not well understood³. Copper IUDs have become more popular in recent years because it is highly effective (only 2% of women will have unplanned pregnancies within the first year), relatively low-maintenance, and cost-effective over the long-term. It contains no hormones and is preferred by women who cannot take hormonal birth control methods. However, copper IUDs can increase cramping, pain and spotting in the first 3-6 months after it is inserted. A woman with a copper IUD will still get her period every month. In fact, the copper IUD is known to increase menstrual bleeding significantly, and has been shown to increase risk of iron-deficiency anemia. For this reason it is not recommended to women with low blood iron, ferritin or hemoglobin⁴. Different versions of the copper IUD are effective for varying time frames, with the ParaGuard being approved for the longest – 10 years. New studies are showing it to be effective at preventing pregnancy for up to 12 years, but should be changed at that point to ensure proper copper levels for efficacy².

Mineral levels in the body are tightly regulated and have significant effects on body processes if levels are too high or too low. In fact, an excess of one mineral can antagonize other minerals and lead to a broader mineral imbalance. Different research groups looking at the effects of the copper IUD have found that blood levels of copper are raised to varying degrees, with newer data suggesting significant increases in serum copper^5,6,7.

Copper is an essential mineral that is used in many body processes, but at excessive levels it is harmful to the body and negatively impacts the level of other essential mineral. A mineral imbalance caused by an increase in copper affects may physiological systems and can lead to hypothyroidism, emotional lability, problems with memory and concentration, poor blood glucose regulation and an increase in inflammatory conditions⁸. According to Julie Casper, L. Ac., and Rick Malter, Ph.D., of nutritional balancing.org, symptoms of copper excess include:

 

Fatigue, exhaustion	Headaches, migraines	Depression	Constipation	PMS
Hypothyroidism	Pounding heart/palpitations	Dry skin	Arthritis, calcium spur0s	Aching muscles
Concentration and memory problems, brain fog	Supersensitive, “over-emotional”	Feelings of loss of control or of hopelessness	Recurrent yeast infections	Low blood sugar and blood pressure
Chocolate cravings	Cold hands/feet	Mood swings	Eating disorders	Obsessive thoughts

“As copper increases in the body, potassium levels will be lowered and calcium levels will increase. This shift has a tendency to slow the activity of the thyroid gland. With the lowering of the potassium, the Na/K (sodium: potassium) ratio will increase, thereby putting the individual in a more chronic “fight” or “flight” response. Sodium may increase with a corresponding drop in magnesium levels. Therefore, a buildup of excess copper will tend to contribute to more intense feelings of fear and anger in a person. As more and more excess copper builds up, it will lead to a shift from anger and fear to rage and terror or panic. Such intense emotion involving rage and terror or panic will leave such a person feeling “out of control.” This is a very common reaction of a person with high copper levels.”⁸

Although researchers have not agreed on the possibility of copper toxicity from this contraception device, case studies are pointing to possible adverse effects, from emotional to physical⁹. Research on human copper toxicity remains “surprisingly sparse,” says Terry Gordon, a professor at New York University’s department of environmental medicine⁹. Animal studies show damage to cervical and ovarian cells from high local concentrations of copper ions from the IUD¹⁰. Perhaps the most significant study done on this topic on humans showed increased systemic biomarkers of oxidative stress and inflammation, and the authors concluded the copper IUD should be used for no more than 2 consecutive years¹¹ as opposed to its usual recommendation of up to 5 years. New research on the etiology of psychological conditions is showing inflammation plays a significant role in the development of mental health concerns. This link shows how copper, inflammation and emotions are all connected.

In terms of mineral imbalances, serum Iron levels have been shown to decrease¹² likely due to increased blood loss from heavier menstruation, as mentioned above. Serum zinc levels have actually been shown to increase with use of a copper IUD^6,12, which is surprising since copper is known to be a zinc antagonist in the body – the mechanism of action of how this occurs remains unknown to researchers. On hypothesis is that serum levels of any mineral other than iron aren’t meant to be high in the blood as they are used by the body at the tissue level. As such, it would make more sense to analyze mineral deficiencies using a tissue sample (ie hair) or urine source and perhaps the research is misguided because the wrong medium is being measured.

It is important to get a good idea of what your chosen method of contraception means for your body in the short and long term. The copper IUD is growing in popularity because of its convenience, effectiveness and absence of hormones, but a broad body of research on it is still lacking. Many women have had successful and satisfactory contraception with the use of a copper IUD. It may still be a good option for you if you are sensitive to other hormonal treatments or prefer it to barrier methods, but it is important to be aware of the link between excess copper, inflammation and emotions. The best suggestion is to get your mineral levels tested by a Naturopathic doctor prior to having an IUD inserted to determine what your pre-existing levels of copper and other essential minerals are. Based on the results, an individualized mineral supplementation program can be created which will help prevent potential side effects that may result after the insertion of the copper IUD. The cost to do a hair essential mineral test is approximately $110.

The Hormonal IUD (Mirena)

The hormonal IUD, Mirena, is similar to the copper IUD in that it is a small device inserted into the uterus and remains there as long-term birth control for up to 5 years, though like the copper IUD, in some circumstances it may be used for longer. It is designed to release small amounts of a form of the female hormone progestin, like that in the oral contraceptive pill, into the uterus. While it is unclear how this inhibits female fertility, it is thought to work by thickening cervical mucus (to prevent sperm from entering the uterus and reaching or fertilizing an egg) and thinning the lining of the uterus (to make it less hospitable to egg implantation if there is fertilization)¹³. In the first 3-6 months after insertion, bleeding and spotting may be irregular but over time many women experience lighter and shorter menstrual bleeding than before insertion, however, some may even see a complete cessation in menstruation¹³.

Mirena is 99% effective in preventing pregnancy and, like the copper IUD, is low-maintenance and cost-effective over the long term versus other methods of birth control. It does contain the hormone levonorgestrel (progestin), but because it is in the uterus the hormone levels are less than is used in the oral contraceptive pill and is effective without having systemic exposure to synthetic hormones.

Less than 1% of women with a Mirena IUD inserted in the last year will become pregnant. However, if pregnancy does occur, it is more likely to be an ectopic pregnancy wherein implantation occurs outside the uterus. This is a potentially life-threatening concern requiring emergency care. Equally unlikely but important to know, the Mirena can also embed itself into or perforate through the lining of the uterus and migrate into the abdomen, causing serious complications requiring surgery. These risks occur in less than 1% of women who are using the Mirena IUD, but they are serious and important to calculate in your decision for birth control. The most common side effects of the Mirena are irregular bleeding (52%), headaches (12%), breast tenderness (3-9%), acne (15%), inflammation of the vulva/vagina (20%), development of ovarian cysts (13%), loss of periods (1-12%), mood changes (4%), and pelvic pain (12%)¹⁴. New studies are claiming that it is effective at preventing pregnancy even up to one year after its FDA-approved time of 5 years, though this may result in more difficulty conceiving after its removal¹⁵. Use beyond 6 years is not recommended as it may be ineffective and lead to unwanted pregnancy.

As there is a chance you may stop your period altogether while using the Mirena, it is a good idea to decide if you feel comfortable with this possibility. Although the Society of Obstetricians and Gynecologists of Canada (SOGC) and the Association of Reproductive Health Professionals (ARHP) state there is no evidence that suppression of periods is harmful, it is important to note that there are no long-term studies to specifically investigate this^16,17. Menstruation, contraception and fertility are deeply intimate topics that have been debated by politics and religion for generations. As a result they can hold cultural significance in addition to their biological purpose. Fortunately women now have the ability to choose the significance for themselves and make that a biological reality. For an in-depth discussion of the history, pros and cons of missing periods, please read the article “A Brief History of your Period and Why you don’t have it” by Psychologist Valerie Tarico in the feminist magazine Jezebel.

“The Ring” and “The Patch”

The ring and the patch are two variations on the combined oral contraceptive pill and therefore have much the same risks, side effects and contraindications as “the pill”¹⁸. Products such as the NuvaRing and Evrapatch deliver female hormones (both estrogen and progestin) for three weeks to block ovulation and prevent pregnancy¹⁸. The ring is inserted into the vagina whereas the patch is placed on the skin. After three weeks of hormone delivery, the ring or skin patch is removed and allows for a withdrawal bleed that imitates a period, like the oral contraceptive pill. These methods work differently than the Mirena because the method of action is to block ovulation and does not necessarily modify the cervical mucus or uterine lining. With perfect use, both the ring and the patch are 99.7% effective at preventing pregnancy and with typical use, 92%¹⁹.

The Diaphragm

This is a barrier method that involves no hormones and no future impact on fertility. The diaphragm is a flexible latex or silicone dome-shaped device filled with spermicide and inserted into the upper vagina covering the cervix. It creates a spermicidal barrier at the cervical opening and must be used with the spermicidal gel to be effective. Women can insert the diaphragm up to 6 hours before intercourse and should leave it in place for at least 6 hours after (up to 24 hrs)¹⁸. If there is more than one occurrence of intercourse in the 24 hours without removal, more spermicidal gel can be added to be sure.

Used correctly and consistently, the diaphragm is 94% effective at preventing pregnancy, though with typical use is 84%. For full effectiveness, the diaphragm does require active participation from the woman: proper hygiene habits and regular insertion, cleaning, removal and storage. Using a diaphragm may increase the incidence of urinary tract infections due to the manual insertion and removal. In the past, it needed to be fitted by a physician as well to ensure comfort and effectiveness.

Up to 25% of married women in 1955 were using the diaphragm¹⁹, but when the birth control pill was introduced and women had the option to have contraception with much less maintenance, the popularity of the diaphragm dropped dramatically. According to the Canadian National Contraception Survey in 2009, only 0.2% of women using contraception choose the diaphragm²¹.

Due to its lowered popularity, there has been limited access to the diaphragm in Canada in recent decades. However, more women are now looking for alternatives to hormonal treatment and the diaphragm is seeing resurgence. New diaphragm products are coming onto the market that are designed to manage some of the drawbacks to the old designs. A new product called Caya, for example, is designed to fit most women and eliminates the need for fitting by a physician. The advantages remain the same as other barrier methods: no hormonal modification or changes to fertility of either party, and the disadvantages are relative to other methods available; the diaphragm requires more active participation from the woman but with proper use is just as effective as using male condoms¹⁹.

Male condoms, with and without spermicide

The use of male condoms is one of the most common methods of birth control. With perfect use it is 98% effective at preventing pregnancy, though this rate drops to 85% with typical use¹⁹. Perfect use means applying the condom before any sexual contact, being sure that it does not slip or tear, and removing it immediately after male ejaculation – and this must be done consistently and correctly every single time. Therefore, technique and consistency is key for this method – it requires commitment from both you and your partner to ensure you are both as protected as possible.

Using additional spermicidal gel or foam can increase the effectiveness of this method, though it’s not confirmed exactly how effective typical use with extra spermicidal protection is. The advantage of condoms is that it is hormone-free and also very effective at protecting against sexually transmitted infections and HIV. It is a lifestyle choice that requires engagement from the male partner and can offer opportunity to talk about sexuality, safety and concerns with each other. Note that it is important not to use latex-based lube with latex condoms or to use two condoms at once as both of these may increase the risk of breakage¹⁹.

Fertility Awareness Method (Rhythm Method)

Fertility Awareness is a way to predict your body’s fertile and infertile times during your cycle. Based on the knowledge that the body shows visible and detectable signs of hormonal changes throughout the cycle, a female can know the date of ovulation, and therefore, know when they are fertile and when they are not. During the fertile periods during the cycle, one must abstain completely from sex or use another effective method to prevent pregnancy. This is a wonderful way to get to know your body as you track cycles and get in touch with what is happening and when. It can be extremely effective if you are diligent and consistent. With theoretical perfect use (meaning you are very good at knowing exactly when you ovulate) it is 95-97% effective. However because this method requires consistent and careful monitoring, typical use falls to about 75%¹⁹.

The fertility awareness method is based on the fact that an egg is released once in each menstrual cycle, usually around mid-cycle, and can live for 12 to 24 hours, waiting to be fertilized before menses flushes out the egg and the uterine lining. Sperm can live in the female reproductive tract up to 6 days and fertilize an egg. Therefore, a female is fertile for as long as six days before ovulation and two or three days after ovulation, a total of seven to eight days of fertility in her cycle each month²². During these fertile days, other contraceptive methods must be used, and outside these days, she is considered infertile and unable to become pregnant. Of course, this method does not protect against sexually transmitted infections.

There are different approaches to detecting ovulation that are available to learn, including using a calendar to track cycles, assessing cervical mucous thickness, checking basal body temperature daily, and breast tenderness²². Keep in mind that your cycle itself can vary depending on many factors such as stress, change, trauma, illness and allergic reactions, making it sometimes difficult to be certain of timing. If you are interested in the fertility awareness method, be sure that both you are your partner(s) are committed and there is consistency in the tracking. If done properly this is a natural and effective way to prevent pregnancy.

Making an Informed Decision

Birth control is an important and intimate decision. If you are looking for alternatives to the oral contraceptive pill, know there are options available for you. Your body does not have to follow any method but what is right for you. Talk with your health care provider about your options, be informed of all the effects of each method and determine what is safe and comfortable for you at this time in your life.

 Relative Effectiveness of Birth Control Methods at Preventing Pregnancy¹⁹

Method used	EffectivenessPERFECT USE	EffectivenessTYPICAL USE
OCP/The Pill	99.7%	92%
The Patch	99.7%	92%
The Ring	99.7%	92%
Hormonal IUD, Mirena	99.9%	99.9%
Copper IUD, ParaGuard	99.4%	99.2%
Diaphragm with spermicide	94%	84%
Male Condoms + spermicide	99%	No confirmed data
Male condoms alone (no spermicide)	98%	85%
Fertility Awareness Method	97-95%	75%
Withdrawal (pulling out)	96%	73%
No birth control	15%	15%

References

All photos used are under a Creative Commons Attribution-Non Commercial-NoDerivs License from the Association of Reproductive Health Professionals at http://www.arhp.org/

1. Society of Obstetricians and Gynecologists of Canada, Canadian Contraception Consensus, SOGC Clinical Practice Guidelines, 2004. http://sogc.org/wp-content/uploads/2013/01/143E-CPG2-March2004.pdf
2. Doyle, K., 2014. IUD Effective for Longer than Recommended. Reuters Health News. http://www.reuters.com/article/us-iuds-effective-idUSBREA2C1B320140313
3. Island Sexual Health, Copper IUD, Beyond the Talk.ca http://beyondthetalk.ca/birth-control-pregnancy/birth-control/ec/copper-iud/
4. Andrade et. al., 1987. Quantitative studies on menstrual blood loss in IUD users Jul;36(1):129-44. http://www.ncbi.nlm.nih.gov/pubmed/3311622
5. Prema et. al.,1980. Serum copper in long-term users of copper intrauterine devices. Fertil Steril.Jul;34(1):32-5 http://www.ncbi.nlm.nih.gov/pubmed/7398904
6. Imani et. al, 2014. Changes in copper and zinc serum levels in women wearing a copper TCu-380A intrauterine device. Eur J Contracept Reprod Health Care. Feb;19(1):45-50 http://www.ncbi.nlm.nih.gov/pubmed/24304153
7. De la cruz et. al., 2005. Blood copper levels in Mexican users of the T380A IUD. Contraception, Vol.72; Issue 2, Pgs. 122–125 http://www.contraceptionjournal.org/article/S0010-7824(05)00075-2/abstract
8. Julie Casper and Rick Malter for Nutr.balancing.org, 2016. Copper Toxicity.http://nutritionalbalancing.org/center/htma/science/articles/copper-toxicity.php
9. Scilla Alecci for Women’s News, 2015. In Online Forums, Women Share Copper IUD Fearshttp://womensenews.org/2015/03/in-online-forums-women-share-copper-iud-fears/
10. Grillo et. al., 2010. Does over-exposure to copper ions released from metallic copper induce cytotoxic and genotoxic effects on mammalian cells? Vol.81;Issue 4, Pgs 343–349 http://www.contraceptionjournal.org/article/S0010-7824(09)00521-6/abstract
11. Arnal et al., 2010. Alterations in copper homeostasis and oxidative stress biomarkers in women using the intrauterine device TCu380A. Toxicology Letters. Vol.192;Issue 3, Pgs 373-378 http://www.sciencedirect.com/science/article/pii/S0378427409015264
12. Fahmy et. al., 1993. Serum and endometrial copper, zinc, iron and cobalt with inert and copper-containing IUCDs.May;47(5):483-90. http://www.ncbi.nlm.nih.gov/pubmed/8513675
13. Official Mirena website, 2016. Bayer Pharmaceutical Company. http://www.mirena-us.com/about-mirena/how-mirena-works.php
14. Medscape 2016. Levonorgestrel intrauterine (Rx) Adverse Effects. http://reference.medscape.com/drug/mirena-skyla-levonorgestrel-intrauterine-342780#4
15. Lawson, A., 2015. Research Shows IUDs May Prevent Pregnancy Longer Than Expected. Surgical Watch.http://surgicalwatch.com/2015/02/research-shows-iuds-prevent-pregnancy-longer-expected/
16. McQuillan et. al., 2013. Menstrual Suppression in Special Circumstances. Clinical Guidelines for the Society of Obstetricians and Gynecologists of Canada. http://sogc.org/guidelines/menstrual-suppression-special-circumstances/
17. Kaunitz et. la., 20018.. Understanding Menstrual Suppression. Association of Reproductive Health Professionals (ARHP) http://www.arhp.org/uploadDocs/understandingmenstrualsuppression.pdf
18. Association of Reproductive Health Professionals (ARHP) , 2014. Choosing a Birth Control Method.http://www.arhp.org/Publications-and-Resources/Quick-Reference-Guide-for-Clinicians/choosing
19. Options for Sexual Health, 2009. Relative Effectiveness of Birth Control Methodshttps://www.optionsforsexualhealth.org/birth-control-pregnancy/birth-control-options/effectiveness
20. CDC, 2002. Use of Contraception and Use of Family Planning Services in the United States: 1982-2002.http://www.cdc.gov/nchs/data/ad/ad350FactSheet.pdf
21. Black et.al., 2009. Contraceptive Use Among Canadian Women of Reproductive Age: Results of a National Survey. J Obstet Gynaecol Can. Jul;31(7):627-40. http://www.sexualityandu.ca/uploads/files/National_Contraception_Survey.pdf
22. Options for Sexual Health. 2009. Fertility Awareness Method. https://www.optionsforsexualhealth.org/birth-control-pregnancy/birth-control-options/natural-methods/fam

What Price do you put on your Health? by Dr. Chris, ND

One way to cure illness is with pharmaceutical pills and medical procedures. Another is to not get sick in the first place. The bonus with the latter option is that it is cheaper in the long run on our strained health care system and it is easier and more likely to prolong your life. Perhaps the time is now for you to take a serious look at proactive health care. That might mean ditching bad habits, eating better, breaking up with fast food, exercising and recognizing danger signs early. When it comes down to it, optimal health is really a matter of choice – your choice. Remember that the cornerstone of prevention is early detection. Minor problems caught early – from infections to mild hypertension to a suspicious lesion – may never turn into a major problem. Also, I think you would agree that physicians should stress prevention but during an MD appointment, there is probably only 5 minutes spent with a patient. That is why, adding a Naturopathic doctor is a must. We spent more time with patients, and are trained in health promotion and prevention.

When I first saw an ND in 1996, I balked at having to pay for the visit, cost of testing and prescriptions. Despite having extended health coverage for Naturopathic medicine, I somehow felt that I didn’t want to pay to get well. I think this comes from the belief that health care in Canada is “free” and we aren’t required to pay for visits to see a Medical Doctor. This is a faulty assumption and health is not free. As they say in economics “there is no such thing as a free lunch”. We all pay for Health Care through our tax dollars. I think we need to examine this belief about not having to pay for health care and what this belief is actually costing you in the long run.

A key question that we have on our intake form is, “What is your level of commitment (%) to address your health concerns” and “what obstacles do you see?” I often see a low commitment level, which concerns me, as essentially I will be more committed to my patients’ health than they are. The most common answer I see as an obstacle to health is finances and cost. I get it. As I mentioned, I also had a hard time justifying the expense… at first. However, now my health is what I value the most. Having faced so many years where I did not value my health, my self-worth, my life, or myself my current view is that my health, and that of my family, is my #1 priority. I think the Dalai Lama quote sums it up quite well. When asked what surprised him about humanity the most, the Dalai Lama replied:

“Man. Because he sacrifices his health in order to make money. Then he sacrifices money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present; the result being that he does not live in the present or the future; he lives as if he is never going to die, and then dies having never really lived.”¹

Health truly is the greatest wealth. I think we have our priorities wrong in Western society. We strive to have material items – big houses with rooms that go empty, expensive cars that pollute our beloved planet, designer clothes, purses and shoes, the latest technological iThis or iThat. Then, when it comes to eating organic meat, produce and grains we say we can’t afford it. And pay out of your own pocket for herbs, homeopathics, supplements, a regular massage or ND consult that will benefit your health in the long run – forget it! If you stop and ask yourself which of the aforementioned items is going to benefit your health, I think you would agree with me that the food you eat and taking care of your health is more important than the type of car you drive, square footage of your house or brand of clothes you wear. I often hear patients say “I won’t be able to come see you anymore because my benefits ran out”. To me, this translates into, “I don’t value my health enough to make it a priority. Someone else is responsible and should pay for my health.” The only person responsible for your health is you.

A quote that is important to keep in mind is “genes load the gun but lifestyle pulls the trigger.” In order to achieve optimum health, you need to make lifestyle changes that are in support of your health – like adding a Naturopathic doctor to your health care team. At the end of the day, it is not climbing the corporate ladder, stuff, things, material possessions or keeping up with the Jones’ that is important. No one on his or her deathbed has ever said “Boy, I wish I had spent more time at the office”. One in twenty patients come to see me for prevention. Ultimately, I’d much rather talk to you about staying healthy in the first place. The best time to have that conversation is when you are already healthy. But, our current Western medical system is in the business of acute care medicine or in the sickness business, not the health business.

Here is a novel idea: reward people for being healthy. Many of my patients, as well as my family, and myself rarely seek support, advice or care from our traditional medical system. Yet, we pay for it in our taxes. Why not reward those that pay for their own health care with a tax incentive. In fact, the Cleveland Clinic in the US does just this – healthy behaviour is rewarded (with cash incentives if necessary) and people have started to think about health as an investment and a responsibility.²

Ideally, the type of change I am talking about would be supported at the corporate level with companies and insurance providers. Today, corporations are paying in lost productivity due to disability claims from many health concerns (i.e. mental health, cancer, heart disease, etc) and this affects them where they care most – their bottom line. Perhaps instead of the stock market rewarding corporate income levels, value should be placed on corporations that have no employees on long or short-term disability due to “stress” leave or mental health concerns. What if we valued THAT in corporate North America? Health consciousness doesn’t come naturally to the average CEO. The only way to justify wellness at the corporate level is to demonstrate that it will lower costs in the long run. Paying for smoking cessation programs or gym memberships only makes sense if a company is reaping some return on its investment. But, if you improve your employees health and decrease sick days, that leads to a boost in productivity. Disability costs for sick leaves decrease for a minimal upfront investment by the employer. In some cases, it doesn’t cost anything to develop a walking program at work. Or to encourage your staff to take the stairs instead of the elevator. Or to park at the opposite end of the parking lot away from the door and walk further to and from work.

As a Naturopathic doctor, I coach people to a healthier lifestyle by teaching:

• nutrition & how to read labels
• about the role of the environment and how it affects one’s health,
• stress management techniques (i.e. meditation and mindfulness)
• proper exercise
• how to shift core beliefs that may be sabotaging their health

Many patients are able to lose weight, quit smoking and reduce or eliminate their dependence on medications. Ultimately the next step will be to see if lifestyle changes can not only hold off disease, but actually reverse it, transforming preventative medicine into a fully developed treatment option on par with prescription and surgical procedures.²

Dr. Dean Ornish has done just that – he created the Preventative Medicine Research Institute in California and developed a lifestyle program for prostate cancer. He showed that the course of prostate cancer could be positively influenced by diet. Men at low risk of prostate cancer were asked to choose either Ornish’s lifestyle program – which involves eating healthier, exercising and reducing stress – or continuing with their current habits.² After three months, Ornish studied the activity of the men’s genes and found that the healthier behaviours turned on cancer- suppressing genes and turned off cancer-promoting ones.² Despite these results, it took Dr. Ornish 14 years to convince Medicare to cover his lifestyle program for avoiding heart disease.²

Don’t wait until you get diagnosed with cancer or have a heart attack to make changes. Make your health matter today! Don’t wait for someday to make the changes you need to make. No one knows how long they have on the planet – life is fragile, precious, a gift and can be gone with a blink of an eye. Pema Chodron wrote: “A cancer diagnosis. Loss of livelihood, wealth, power. The unexpected end of a relationship. A broken promise, a shattered dream. Sometimes impermanence smacks us in the face without much warning. It was always there, of course, lurking in the background, we’ve just been distracted, or fallen into illusions of permanence, or turned our backs in horror. Impermanence comes, sometimes out of the blue, to remind us of what is essential and true, to shatter our spiritual laziness and remind us of the true path.”

So, I ask you – what can you do without, live without or return to the store so you can afford Naturopathic care? Maybe it’s that daily coffee, maybe it is eating out for lunch or dinner 2-4x/week, maybe it’s getting a lower data plan on your cell phone, maybe it’s cancelling cable, maybe it’s quitting smoking, maybe it’s shopping second hand, maybe it’s walking or biking to the store instead of driving, maybe it’s downsizing from a 3000 sq. ft. home to a 1500 sq. ft. home, maybe it is buying a second hand vehicle instead of a new one or maybe it is planting a garden to reduce your grocery bill. What will it take for you to realize that your health is in your hands? The current medical model is a crisis care system not a health promoting system. The best option is prevention and being proactive with your health. It is a timeless idea, one that our species has always practiced: pioneers preserved food to prevent starvation in the winter; modern workers invest in RRSP plans to prevent destitution when they are older.² Applying the same principles to medical care should not be that hard – especially since our country’s health, economic and otherwise, may depend on it.² If you want to promote your health, see an ND. It truly is the best investment you will ever make. You are worth investing in your health.

References:

1. http://www.mindbodygreen.com/0-6159/10-Inspiring-Quotes-From-the-Dalai-Lama.html
2. Time Magazine. The Health Issue. How Not to Get Sick. Page: 60-67, June 22, 2009

I am in the process of finishing the last chapter of my book: Beyond the Label. This chapter is titled the Myths of Mental Illness – and I am up to 37 myths – whoa! I thought I would share one of these myths in a blog post:

Myth #13 People will look at you differently if you reach out for help.

The fear surrounding this myth is common to many health conditions. It is the fear of being seen for who we really are. And without even talking about mental illness, it is one of the biggest obstacles to our true happiness. As a culture, we are afraid of being seen and make huge efforts to always ‘put our best face on’ for the world, showing only the happy/desirable/social-media-appropriate sides of ourselves while hiding, shaming and disowning the shadow sides. This tendency is what keeps us from having true connection. Tragically, it is what keeps us from ever feeling truly loved. How can we believe that we are truly loved (all parts of us) if we never show ourselves? When we get positive feedback on the groomed face we use for the world, we reinforce the belief that the ungroomed face would not be accepted and we must keep up the efforts to stay ‘presentable’. Mental illness unfortunately only thrives under the effect of this fear, deepening the groove that tells us we need to hide the undesirable parts of us. The truth, however, is powerfully contradictory. There is strength, courage and beauty in being able to show all parts of oneself, though it is uncomfortable.

Think about the last time a person truly opened up about something painful, and you saw that they acknowledged it, were working towards accepting it, and trying to love themselves and others despite their perceived “flaw”. What did you feel for that person? Compassion and frustration that they should have to deal with such stress and negativity? Were you wishing they could see themselves as you see them? Whenever I was brave enough to share my mental health labels (which include depression, anxiety, social phobia, bulimia and the big whammy of bipolar disorder type 1) with someone, I often expected something entirely different: judgment, a collapsing of our social status, loss of a friendship, misunderstanding, perhaps pity and a permanent shameful mark on my identity.

When we see someone who is bearing all, asking for help and reaching out, we are witnessing an act of vulnerability. Vulnerability, as Brené Brown says, is the best measure of our courage. By reaching out you give permission to others to be more honest with the world as well. It is an example of how we can be more whole-faced with each other. Perhaps the best way to debunk this myth is not by denying it wholly. Let’s talk about it. If you are dealing with mental health concerns and you reach out for help with honest, open hands and are seen for all you are, shadow and light, people will see you differently. They will see you as being strong enough to be seen and to admit, accept and work with all parts of yourself. They will watch and say, “that is a whole person”. And they will be emboldened to do the same for themselves.

If you are currently navigating the road to wellness with your mental health and need an allied health partner in the process, please contact the clinic for ways that I can be of service to you.

10 Reasons you need to see a Naturopathic Doctor

1. You want to maintain your health
2. You want to prevent getting a chronic health condition, such as, heart disease, cancer, mental health, Type 2 diabetes
3. You want to see how good you can actually feel
4. You want to become a “Super Senior”. A Super Senior is someone over the age of 85 that has never had or does not take medication for one of the following health concerns: cancer, heart disease, osteoporosis, type 2 diabetes, dementia/Alzheimer’s or pulmonary diseases (COPD, emphysema)
5. You are sick and tired of being tired and sick
6. You want to know if there is a natural alternative to the prescription medications you are taking
7. You don’t know what supplements to take, which ones are good quality or what does is necessary
8. Your doctor tells you your symptoms are all in your head
9. You are confused about all the diets out there and don’t know what to eat
10. The medications you take cause side effects, which require you to take another medication, which causes another side effect. You are concerned about this poly-pharmacy approach.

As naturopathic doctors, the following principles guide us:

 ~ Treat the cause: NDs seek to identify and remove the underlying causes of illness, rather than to merely eliminate or suppress symptoms.

 ~ First, do no harm: therapies should stimulate the body to heal in a gentle and effective manner, not causing unwanted side effects.

~ Treat the whole person: Health and disease involve a complex interaction of physical, spiritual, mental, emotional, genetic, environmental, and social factors. NDs must treat the whole person by considering all these factors; therefore, a personalized and comprehensive approach to diagnosis and treatment is required.

~ Doctor as teacher: NDs educate and encourage patients to take responsibility for their health.

~ The healing power of nature: use natural therapies that encourage the body to heal itself.

~ Prevention: The ultimate goal of Naturopathic Medicine is prevention. This is accomplished through education and promotion of lifestyle habits that foster good health. The emphasis is on building health and using prevention as the best cure, rather than fighting disease.

 Get started on the road to optimal health today! Contact us at 587-521-3595.

New Services: Meal Planning, Kitchen Cleanse, Grocery Tours and Diet analysis

Meal Planning

How many of the following statements apply to you or someone you know:

• Do you lead a busy lifestyle and just don’t have the time to plan meals?
• Are you opting for take-out and restaurants more than you’d like?
• Does thinking about what to make for supper stress you out?
• Do you need some variety in your meals and snacks?
• Are you ready to make positive changes to your diet and lifestyle, but are unsure where to start?

If you want to feel healthier, have more energy, improve your digestion, lose weight or address a reoccurring or underlying health condition, We’re here to help. Let’s reduce some of your stress by saving you time and the effort to meal plan for your week.

After meeting for a 20-minute initial meal plan consultation and completion of a questionnaire to provide an overview of your dietary and lifestyle habits and to address any roadblocks to success, a one- or two-week meal plan will be created for you. Meal plans will focus on a balanced, whole foods diet, and your personalized meal plan will reflect your likes, dislikes and health goals as well as take into account any pre-existing medical conditions.

What’s included in your custom meal plan package:

• One personalized meal plan with recipes (including breakfast, lunch, supper and snacks)
• Full grocery list
• Tips and tools for success

Offered by Dr. Candace Haarsma who has a special focus in nutrition and has advanced training in nutrition receiving the designation of Culinary Nutrition Expert from the Academy of Culinary Nutrition.

Investment:

7 day meal plan- $150

14 day meal plan- $250

Kitchen Cleanse

• Do you wonder if the foods and ingredients in your kitchen are helping or hindering your health goals?
• Do you feel like you need more health guidance in your own kitchen pantry and fridge?
• Are you ready to transition to a whole foods household?
• Are you going gluten or dairy free?
• Do you or someone in your household have a food allergy or sensitivity that you need help navigating?

No matter what your health goals are, this service is designed to take out the guesswork. We will identify the items preventing you from reaching your optimal health and wellness—going through each item one by one, box by box and can by can. We will also help you understand why those items are undesirable and are hindering your goals, including label reading so you can feel confident when grocery shopping.

You will receive a personalized grocery list for your next grocery shopping trip containing healthful, nourishing alternatives and replacement items to re-stock your kitchen. Additionally, we will provide information and tips about food storage. By the end of the process, you will feel confident and empowered to make healthful choices about what food items and ingredients to bring into your home and stock your pantry with.

Includes:

• 90 minute in-home pantry and fridge assessment and makeover, following completion of a questionnaire identifying your goals and obstacles in the kitchen
• A kitchen cleanse re-stock shopping list
• Label reading and food storage tip sheets
• Three customized recipes considering your needs and preferences

Investment: $200 (locally in Edmonton)

For surrounding areas to Edmonton, please contact for pricing.

Offered by Dr. Candace Haarsma (mentioned above) and Dr. Lorraine McCarthy who is a Naturopathic Doctor who lives in a family with food intolerances. She is passionate about whole foods eating and living and has a keen focus on the role the environment plays in our food and health.

Grocery store tours:

Grocery shopping – love it or loathe it, it must be done. Often. However, with so many food choices available today, shopping is not simple, especially if you have optimal health in mind.

• Do you ever find yourself in a grocery aisle unsure of what item to put in your cart?
• Do you ever wonder if there is a healthier option than the one you are choosing?
• Do you ever feel confused reading the ingredient list or nutrition label?

Shopping doesn’t need to feel so confusing or intimidating. Helping people make healthy food choices is a passion of Naturopathic Doctors, so allow one of us to guide you. We will meet you at the grocery store to educate and empower you to shop for better health for you and your family. We can also help you navigate how to shop for a food sensitivity.

We will meet you at your preferred store. We will discuss:

• Tips for choosing healthy foods
• Which ingredients to avoid
• How to read nutrition labels
• Decoding ingredients
• Healthy snack and on-the-go options
• Organic foods which are the most important
• Natural and artificial sweeteners
• Which oils are best and why
• Alternatives for foods you may be avoiding– e.g. dairy, gluten, meat, grains
• Hidden sugars
• Meal planning tips

Relevant handouts will be provided at the tour. Tours are kept one-on-one or a maximum of two people so there is ample time to answer all the questions you have.

Tours last one hour. Personal tours are $175; a two-person tour is $200.

(Additional commuting charge may apply for surrounding areas.)

Please contact the clinic at 587-521-3595 to schedule your personal grocery tour with one of our amazing Naturopathic Doctors.

Diet analysis

Do you wonder if the food you are eating is meeting your nutritional requirements. We offer a dietary analysis which looks at the food you are eating from 3 perspectives: 1) a macronutrient persperctive 2) a micronutrient perspective and 3) an environmental perspective. Many holistic nutritionists only focus on the first two points, but Naturopathic doctors at the Natural Terrain Naturopathic Clinic have special training in all three areas – which helps to maximize your health!

Includes a personalized dietary outline of the your diet from the 3 perspectives mentioned above, as well as recipes and suggestions on how you can improve your health.

Investment: $75 (for existing patients only and patients are to provide a 3 day diet diary). Please discuss with your Naturopathic Doctor.

Please contact the clinic at 587-521-3595 to schedule any or all of our new services!!!