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Shift Work and Hormone Balance

Hormones, tiny messenger compounds in our bodies that control our appetite, sleep, energy, reproduction, mood and libido. These little powerhouses are responsible for hundreds of different actions in our bodies. Is it any wonder that they can be negatively impacted by shift work? Ask any nurse, police officer, paramedic, or other person who regularly works shift work and they will certainly tell you that their appetite, sleep or energy have been impacted!

So what is happening to our hormones when we do shift work? What are the consequences, and is there anything we can do about it? This article will answer these questions, and more.

The Circadian Rhythm – Your Body’s Clock

Many different processes in our body occur in a daily rhythm. That rhythm is set by our body’s internal clock – the circadian rhythm. This internal time-keeper, located mostly in our brain in the suprachiasmatic nucleus (found in the front of the hypothalamus), regulates our sleep-wake cycle, body temperature, digestion, and our hormone balance. When this rhythm is disrupted by shift work, it is unsurprising that hormone imbalances and sleep problems are some of the most common consequences.

Most of the hormones in our body are influenced by our circadian rhythm. Most notable are melatonin, cortisol, growth hormone, leptin and ghrelin. We’ll also be looking at how changes in our circadian rhythm impact our ability to make energy from our food and some of the known negative consequences of a regularly disrupted circadian rhythm.

Melatonin

The hormone we tend to think about when we think about sleep, melatonin is the best example of a hormone that runs on a daily rhythm. Produced in our pineal gland in our brain, melatonin levels rise in the evening when our eyes are exposed to less light, and they fall towards the morning hours. Regardless of your work hours, studies have found that melatonin levels still become elevated during the dark hours of night. However, compared to people who work only day shift, people who work shift work have significantly lower melatonin levels during daytime sleep – leading to poorer quality and quantity of sleep. And melatonin isn’t important only for sleep – it is also a powerful antioxidant in our bodies and influences our immune function to reduce inflammation.

While studies are mixed, most suggest that people who work shift work may benefit from taking melatonin to help mimic a more regular sleep-wake circadian rhythm. It can reduce time to fall asleep during the day, as well as allow you to sleep for longer.

Cortisol

Cortisol is most often thought of as a stress hormone, but it is so much more than that. Cortisol is produced to help us respond to stress, but it also has it’s own daily rhythm with levels rising in the early hours of the morning, and peaking about 30 minutes after waking. Pulses of cortisol are also produced during the day in response to stress. Cortisol helps us to adapt to stress in our environments – whether those stresses are physical, environmental, or mental and emotional.

In people working night shifts over long periods of time, there has been found a decrease in the total amount of cortisol produced, with studies finding up to 43% lower levels! In people who work swing shifts one study found that the reductions in cortisol production did not completely normalize, even after four weeks of holidays.

Low levels of cortisol can have pretty significant impacts on your health, including low energy, irritability, poor stress tolerance, insomnia, and poor immune function. The imbalance in cortisol resulting from shift work is thought to be one of the most important factors in developing health conditions, such as obesity, diabetes, and some cancers, associated with sleep deprivation and shift work.

Growth Hormone

An important hormone for supporting growth in our youth, and remodeling our bodies in adulthood, growth hormone levels increase during sleep, and peak shortly after falling asleep. When sleep is shortened or disrupted, growth hormone levels do not reach their optimal peak. This can lead, over time, to lower bone density, decreased muscle mass, fatigue, depression, and poor memory.

An interesting finding from research is that people with posttraumatic stress disorder who experience frequently disturbed sleep typically have lower nighttime growth hormone levels compared to healthy control subjects.

Ghrelin and Leptin

Two hormones most people have never heard of, ghrelin and leptin are two of the primary drivers of appetite and food consumption. Ghrelin, a hunger hormone, promotes appetite and food intake. Levels tend to increase just before your typical meal times, and decreases after. Leptin, on the other hand, is the hormone of fullness, and levels decrease as your stomach fills with food. There is a delay in leptin production after food consumption – one of the main reasons so many doctors (myself included!) suggest eating slowly – to allow leptin levels to rise and prevent overeating.

When people don’t have regular meal times, or they vary significantly, and when sleep deprivation is an issue (both common consequences of shift work), people tend to experience significant peaks in ghrelin, leading to a corresponding increase in hunger and appetite. With sleep deprivation we also see consistently across studies that people tend to consume more foods, especially those high in carbohydrates due to increased hunger and decreased satiety. People who sleep fewer hours (5.5 hours) also tend to snack more, consuming around 220 calories per day from additional snacking.

Energy Metabolism

The way our body uses carbohydrates and fat for energy varies with our sleep-wake cycles. This is not surprising, given that we have greater energy demands when we are awake than when we are asleep. People who do shift work may find that the disordered circadian rhythm can lead to poorer blood sugar control, higher spikes in blood sugar after meals, more insulin resistance, and higher body fat mass. These hormone imbalances can ripple into high cholesterol (especially damaging triglycerides), diabetes, obesity and heart disease.

Consequences of Shift Work

Having a disrupted circadian rhythm can impact much more than your sleep. Many people who work shifts have found that their mood, energy, appetite, and many other aspects of their lives are impacted by shift work. And there are some known consequences of shift work that we all should be aware of, so that we can make efforts to reduce the risk of these conditions impacting our quality of life.

Obesity

Sleep deprivation has been found consistently in studies to be a strong predictor of obesity. According to the National Sleep Foundation, the average number of hours of sleep for an adult is around 6 hours 40 minutes, compared to 8 hours and 30 minutes in 1960. For people who get less than 6 hours of sleep per day (or more than 9) studies have found a greater tendency towards gaining visceral fat – the type of fat that accumulates around the abdomen and impacts healthy organ function. Poor sleep can also impact appetite and lead to food choices that promote weight gain.

Diabetes

A consequence of both obesity and the blood sugar dysregulation that are common in both sleep deprivation and shift work, diabetes is a major concern for North Americans. Even short term sleep restriction (as few as four nights), as often happens with people working shift cycles, can lead to reduced sensitivity to insulin, increased blood sugar levels and increased lifetime risk of developing diabetes.

Breast Cancer

A little-known consequence of low melatonin is an increased risk of breast cancer. With imbalanced melatonin levels a common side effect of shift work, there is a potential increased risk of breast cancer in women who work shift work long term.

Surviving Shift Work

Learning about the hormone imbalances of shift work can help you to understand how your body, mood and energy may be impacted by shift work. But it shouldn’t stop there. It is important to turn information into action and take steps towards reducing the risks associated with shift work. While many people cannot choose to work a non-shift work schedule, you can choose your diet, lifestyle, and sleep behaviours to maintain your quality of life and keep you healthy through all the shifts in life.

Select References:

Kim TW, Jeong J-H, Hong S-C. The impact of sleep and circadian disturbance on hormones and metabolism. Int J Endocrinol. 2015;2015:591729. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377487/

Davis S, Mirick DK, Chen C, Stanczyk FZ. Night shift work and hormone levels in women. Cancer Epidemiology Biomarkers and Prevention. 2012;21(4) http://cebp.aacrjournals.org/content/21/4/609

Mirick D. K., Bhatti P., Chen C., Nordt F., Stanczyk F. Z., Davis S. Night shift work and levels of 6-sulfatoxymelatonin and cortisol in men. Cancer Epidemiology Biomarkers and Prevention. 2013;22(6):1079–1087. https://www.ncbi.nlm.nih.gov/pubmed/23563887

Harris A., Waage S., Ursin H., Hansen Å. M., Bjorvatn B., Eriksen H. R. Cortisol, reaction time test and health among offshore shift workers. Psychoneuroendocrinology. 2010;35(9):1339–1347. https://www.ncbi.nlm.nih.gov/pubmed/20399022

Knutson KL, Van Cauter E. Associations between sleep loss and increased risk of obesity and diabetes. Ann N Y Acad Sci. 2008; 1129():287-304. https://www.ncbi.nlm.nih.gov/pubmed/18591489/

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem. 

Adenomyosis – The Missed Diagnosis for Women

In the realm of women’s health, most women have heard of PCOS, endometriosis, or fibroids.  But mention a diagnosis of adenomyosis and you’ll be met with blank stares.  Why is one of the most common uterine conditions something most women have never even heard of?

Adeno-whaty-osis?

Adenomyosis is a condition that is very similar to endometriosis.  In adenomyosis the inner layer of the uterus, the endometrium, pushes into the muscular layer of the uterus, the myometrium and decides to stay there. Endometriosis occurs when those same endometrial cells set up shop outside the uterus – on the outer walls of the uterus, the ovaries, the fallopian tubes and throughout the abdominal cavity. 

Unlike endometriosis, in most cases of adenomyosis, the endometrial cells that are out of place are not functional – they don’t respond to the hormones of our menstrual cycle and go through the paces of shedding blood each month. 

A Common(ly Missed) Diagnosis

We don’t really have a good estimate of how many women are currently experiencing adenomyosis.  Unlike many other gynecological conditions, adenomyosis diagnosis criteria aren’t as well established internationally.  Some studies estimate up to 20-30% of reproductive aged women may have adenomyosis. 

Up until recently the only way to diagnose adenomyosis was to do a hysterectomy, and then take a look at the layers of the uterus. Now (thankfully) we can diagnose adenomyosis through an MRI. 

Symptoms of Adenomyosis

Half of women with adenomyosis will never have symptoms that are significant enough for them to seek care.  They may notice they are having heavier or more painful periods, but they often chalk it up to getting older.  Women who do experience symptoms tend to be older – between the ages of 35 and 50.  Adenomyosis is rare in postmenopausal women, except when the drug tamoxifen is involved. 

Classic symptoms of adenomyosis are:

  • Painful periods
  • Heavy periods
  • Abdominal pressure and bloating
  • Pain during sex

In adenomyosis the uterus is also enlarged and lumpy, but most women wouldn’t notice this until it gets really enlarged. 

If It’s Not Adenomyosis

The most common misdiagnosis for adenomyosis is uterine fibroids.  Another type of benign (non cancerous) growth in the uterus, fibroids can grow in the wall of the uterus, on the outside wall of the uterus, just under the uterine lining or hang into the uterus.  Both adenomyosis and fibroids cause heavy and painful periods.  And some unlucky women can have both these conditions at the same time. 

Treating Adenomyosis

Adenomyosis is more common as women get older, and the potential for estrogen dominance increases.  Many women respond well to approaches for reducing estrogen dominance such as DIM, I3C, calcium d-glucarate, B-vitamins, probiotics and bioidentical progesterone.  Other options include treatments that reduce heavy periods, such as shepherd’s purse and ginger.  Anti-inflammatories such as turmeric and ginger may also be helpful for reducing the cramping associated with adenomyosis. 

Most importantly, you should consider working with a Naturopathic Doctor or functional medicine practitioner to develop a strategy for managing your adenomyosis symptoms, especially if you want to prevent a hysterectomy down the road.  Working with someone who can guide you to optimal hormone balance can be life-changing for women with adenomyosis, and the consequences of hormone balance (better moods, more libido, more energy) can help you live the fired up life you deserve.

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem. 

Selected References

Taran FA, Stewart EA, Brucker S. Adenomyosis: Epidemiology, Risk Factors, Clinical Phenotype and Surgical and Interventional Alternatives to Hysterectomy. Geburts Frau. 2013;73(9):924-931. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3859152/

Naftalin J, Hoo W, Pateman K, Mavrelos D, Holland T, Jurkovic D. How common is adenomyosis? A prospective study of prevalence using transvaginal ultrasound in a gynaecology clinic. Human Repro. 2012;27(12):3432-3439.

Endometriosis and Fatigue

One of the most common symptoms of endometriosis is one that is not being adequately assessed or managed – fatigue.  A 2018 study found that a majority of women with endometriosis experienced fatigue, a significantly higher number than in a control group of women.

Fatigue and Endometriosis

Women often report fatigue to their doctors, and many are disappointed by the lack of concern, or downright dismissal, of their symptoms.  Women in my practice have heard:

            “We’re all tired”

            “You’re just getting older.  Feeling tired is part of aging.”

            “Tired is just another word for being a parent.”

            “Try getting more sleep, you’ll feel better after a good night’s sleep.”

            “I could give you some Ambien…”

The reasons why women with endo have more fatigue are likely different, depending on the woman’s experience.  Some common contributing factors identified in the study include insomnia and sleep loss, depression, pain (causing both depression and sleep loss), and significant stress.  Living with a chronic pain condition like endometriosis is likely to be a drain – on your body, on your mind, on your emotions, and on your energy.

Managing Fatigue in Endometriosis

Unfortunately, many doctors don’t screen women with endometriosis for fatigue, and are not offering treatments to women who do report fatigue.  But there are some things you can do.

  1. Remove gluten from your diet.  Studies have found that eliminating gluten from your diet can reduce pain associated with endo for about 75% of women.  Removing gluten can also reduce brain fog and improve energy.  I suggest doing at least 6 weeks gluten free to see how it can impact your endo, and your energy.
  2. Take an omega 3 fatty acid supplement.  Used by the body to reduce inflammation, omega 3s also help to keep your nervous system, including your brain, functioning optimally.  Studies suggest that women with endometriosis take between 1-3g of omega 3s per day.  If you choose a fish based omega 3, be sure to choose one that is free of mercury, PCBs and other contaminants.
  3. Get a good night sleep.  There is nothing that will zap your energy more than a poor night sleep.  And if you can’t sleep, consider taking a melatonin supplement.  One study found that taking melatonin decreased pain scores in women with endo by almost 40% – not to mention how it impacted their sleep! 
  4. Try meditation.  It’s a bit cliché, but seriously, if you aren’t meditating, why not??  The benefits of meditation are almost too numerous to count, but improving sleep, calming stress, improving mood and supporting energy are certainly among them.  Meditation doesn’t have to be hard – you can download free, or inexpensive apps, and meditating for just 10 minutes a day can have positive benefits.  So give it a try, seriously! 
  5. See your Naturopathic Doctor.  Ultimately, fatigue is a real symptom of endometriosis.  It may be overlooked by many doctors, but it should not be overlooked by women.  You have the capacity to abundant energy, to share your magnificent self with the world.  When you work with an ND you get the ultimate in personalized medicine.  Your ND will help you to develop a strategy to treat your symptoms of endometriosis – including fatigue. 

Disclaimer

Fatigue is a common symptom of endometriosis.

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem. 

Select References

Ramin-Wright A, Kohl Schwarts AS, Geraedts K, et al. Fatigue – a symptom in endometriosis. Human Reproduction,33(8);2018:1459-1465

Schwertner A, Cocneicao Dos Santos CC, Costa GD, et al. Efficacy of melatonin in the treatment of endometriosis: a phase II, randomized, double-blind, placebo-controlled trial. Pain. 2013;154(6):874-81.

Marziali M, Venza M, Lazzaro S, Lazzaro A, Micossi C, Stolfi VM.  Gluten-free diet: a new strategy for management of endometriosis related symptoms? Minerva Chir. 2012 Dec:67(6):499-504.

Endometriosis Staging

Many women in my practice have never heard of endometriosis before they are diagnosed with it.  And often that diagnosis took years to get.  Endometriosis is a notoriously difficult condition to diagnose – it can’t always be seen on an ultrasound and diagnosis often requires an MRI or a surgical procedure (a laparoscopy) to identify the endometriosis and provide information on staging.

The symptoms of endometriosis are often ignored as well, both by women and their health care providers.  Many women have to see 3 or more doctors before they receive an appropriate diagnosis – and delaying diagnosis can make this already difficult condition even more difficult to treat.

Endometriosis Staging

Once a diagnosis of endometriosis is made many women are given a staging level for their endo.  The American Society for Reproductive Medicine classification is based on a point system looking at the following characteristics:

  1. Location and size of the endometriosis – on the peritoneum and ovary – and whether it is superficial or deep
  2. Obstruction (obliteration) of the cul de sac – partial or complete
  3. Adhesions on the ovary and fallopian tubes – filmy or dense and their overall size

Based on the points given for these findings, a stage is given. 

            Stage I – Minimal endometriosis (less than 5 points)

            Stage II – Mild endometriosis (6-15 points)

            Stage III – Moderate endometriosis (16-40 points)

            Stage IV – Severe endometriosis (>40 points)

*Follow the link for the exact point calculations. 

Concerns with Staging Endometriosis

While staging of endometriosis can be useful for women and their health care providers to understand the overall appearance of the endometriosis, the staging system has some flaws.

The staging system only describes what the endo looks like – it doesn’t help a woman (or her health care team) predict pain levels, response to medications, risk for associated conditions, or quality of life.  Women with Stage IV may have minimally painful periods, while women with Stage I may suffer incredibly each month. 

Ultimately, I don’t treat women based on staging of their endometriosis.  I treat women based on their symptoms and their desired outcomes.  A woman who wants to get pregnant will be treated differently than a woman who wants to reduce pain – every woman in my practice is treated individually to help her achieve her optimal state of health while living with endo. 

For more information on endometriosis, check out the other articles in my endometriosis series, including Understanding Endometriosis, Endometriosis in Adolescence, Endometriosis and Infertility, The Endometriosis Diet and Endometriosis and Naturopathic Medicine.

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem. 

The Many Colours of Menstruation

You may be used to seeing your period every month, but it can still surprise you when it shows up and it’s a different colour.  Bright red, dark red, brown, orange or even black… are these normal?  And what do they mean?? 

Let’s go through the different colours in the period rainbow, and help you understand what they mean.

Bright Red Period Blood

Typically found during the first days of your period, or on heavy days, bright red blood indicates that the blood is fresh and flowing quickly.  It may be free of clots or have some clotting depending on how heavy the flow is. 

Dark Red Period Blood

Dark red blood is blood that has been stagnant in the uterus for a little while.  Often the result of lying down and sleeping overnight, the blood has been partially oxidized resulting in a darker colour.  For many women this darker blood is also found during the last days of their period when blood flow is slower, allowing for more time for the blood to oxidize and darken. 

Brown Period Blood

Brown blood is a continuation of the oxidation process that leads to dark red period blood.  It has just been sitting stagnant for longer.  Often associated with very light flow, brown spotting often occurs at the very start of the period, before flow really gets going, or at the very end when flow is slowing down to just a few drops. 

Black Period Blood

This one freaks women out, but it’s just a step further than brown blood.  Often having an almost coffee ground like appearance, black blood is more fully oxidized than brown blood.  It’s nothing to be worried about, unless it happens all the time, in which case you should look at having an ultrasound done. 

Pink Period Blood

Pink period blood usually occurs at the beginning or the end of your period, when the flow is light or spotting.  Pink blood results from the menstrual blood mixing with cervical fluid and vaginal secretions, diluting the colour.  This pink colour is often also seen during ovulation spotting, when cervical fluid production is at its peak. 

Orange Period Blood

A variation on pink period blood, orange period blood also occurs when menstrual blood mixes with cervical fluid or vaginal secretions.  It can occur during ovulation, implantation and when period flow is light. 

Grey Period Blood

Any shade of grey is a reason to see your doctor.  Grey blood, or discharge could be associated with bacterial vaginosis, especially when there is an unpleasant odour associated with the discharge.  So get this one checked out!

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

The Most Important Test for Preventing Miscarriage

Pregnancy is one of the most significant women’s health topics – we spend our teens and early 20’s avoiding pregnancy, and many of us spend our 30’s and early 40’s trying to get pregnant.  And once a woman is pregnant, we want to ensure a healthy pregnancy with the outcome of a happy, healthy baby.

Lack of Lab Testing

In Ontario, where I run my women’s health practice, the standard of care is for women to receive only very basic testing when they discover they are pregnant.  Women are screened for sexually transmitted illnesses (chlamydia, gonorrhea, syphilis), public health testing (rubella), blood type and Rh factor.  But few women are screened for one of the most common, and preventable, causes of miscarriage – one that can be easily identified and often has no symptoms. 

Comprehensive Testing

The one test I insist all women in my practice have at the first sign of pregnancy is a comprehensive thyroid panel.  The thyroid gland, sitting in your throat near your voice box, is one of the most important hormone producing gland in your body.  Thyroid hormones are essential for metabolism – creating energy in our cells to meet the demands of our body.  In pregnancy we need to be able to make a lot of energy – making a whole new human is hard work! 

In pregnancy our requirements for thyroid hormones increase – and if our body isn’t able to meet that demand, the result can be early pregnancy loss (miscarriage).  We can identify women who may be at risk for this by running a simple TSH (thyroid stimulating hormone) test and treating women who fall outside the normal range with thyroid replacement hormones during pregnancy. 

But TSH isn’t the only important thyroid test for a pregnant woman.  Testing thyroid antibodies, especially anti TPO antibody is also essential for preventing miscarriage.  Thyroid autoimmune disease is the most common autoimmune disease in women who are in their childbearing years – impacting up to 15% of women.  Many of these women have no symptoms of thyroid disease and their TSH levels are totally normal.

Having TPO antibodies however, is a major risk factor for miscarriage.  There is a strong association with TPO antibodies and miscarriage, preterm delivery, and other negative outcomes in pregnancy (such as low birth weight and smaller head circumference). 

Getting Tested

Despite all the evidence, known to doctors since the 1990s, comprehensive thyroid testing still isn’t available as a screening test for most women in early pregnancy. But that shouldn’t stop you from seeking it out. Available from your Naturopathic Doctor for under a hundred dollars, this test could make all the difference in your pregnancy. And since this cause of miscarriage is completely treatable, I encourage you to have the test done as soon as possible after you discover you are pregnant. Miscarriage is all too common already, I don’t want any more women to have miscarriages that could be prevented.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.


Going Grey

Purple, blue, red, pink – bright vibrant hair colours are all the rage these days!  But grey?  Is anyone really excited to see those grey hairs popping up?  Why are they there, and what can we do about it?  The answers may surprise you.

Aging Grey

Our hair follicles contain cells that make pigment, called melanin.  This melanin gives your hair its distinct colour.  As we age, these pigment cells start to die off and new hairs grow in lighter – in an array of shades from grey to silver and white.  Once that pigment cell is dead, it won’t come back – the hairs growing from that follicle will never be coloured again. 

And aging is inevitable.  Dermatologists often quote the 50-50-50 Rule – 50% of the population will be 50% grey by 50 years of age.  However, it differs for everyone.  It seems that white people tend to start going grey in their 30s, Asians in their late 30s and black people in their mid-40s. 

Grandma Was Great, and Grey

But it’s mostly your genes that determine how early you go grey – and how quickly!  (Thanks Mum.)  If your parents went grey early, it’s more likely that you will too.

Premature Greying

Genetic or otherwise, premature greying happens.  If you go grey 10 years earlier than the average person does, feel free to complain about it!  You can consider it premature if your hair is going grey before:

  • 20 years old if you’re white
  • 25 years old if you’re Asian
  • 30 years old if you’re black

Contributing to the Grey

There are health concerns that can contribute to grey hair.  If you’re convinced it’s not all in your genes, look at these factors to see if they are adding to your silver streaks.

  1. Lack of vitamin B12 – common in vegans and vegetarians
  2. Vitamin D deficiency – common in northern climates, especially during the winter months
  3. Low calcium – from poor intake or a parathyroid dysfunction, low levels are associated with premature greying
  4. Low iron levels – more common in women and vegans and vegetarians, low levels can contribute to greying and to hair loss
  5. Thyroid hormone imbalance – more common in women, impacting up to 1 in 6 women
  6. Vitiligo – an autoimmune disease that destroys pigment making cells
  7. Copper imbalance – copper can boost the production of melanin, the compound that gives hair its colour.  But don’t just start taking it – copper needs to be carefully balanced with zinc or it can cause mood swings, depression and anxiety.
  8. Smoking – smokers are much more likely to go grey before 30 years of age – 2 ½ times more likely!

What To Do About Grey Hair

Dye it or don’t, but whatever you do don’t pluck it!  Or at least don’t make a habit of it!  Repeatedly plucking hairs can damage the hair follicle and result in kinkier, less healthy hair growing in. 

Hair is made mostly of protein, so foods that are high in proteins are essential for healthy hair.  Nutrients like iron, calcium, zinc, vitamin D, omega 3 fatty acids, B12 and B6 have also been found to support hair health.  Some vegetarians and vegans, and people with digestive issues, may have difficulty getting enough of these from their food and might want to look at taking targeted supplements. 

Eating every 4-5 hours may also help to support hair health.  Hair is not considered an essential tissue by the body, and research suggests that if we go too long between meals the energy available to non-essential tissues could be reduced and could impact hair health. 

Consider having your nutrient levels tested to see if they are negatively impacting your healthy hair. And meet with a Naturopathic Doctor to discuss your diet if you feel like it could use a boost as well!

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Vegan and Vegetarian Lab Testing

You don’t choose a vegan or vegetarian diet because you want to feel tired and depleted.  You choose it because you know it can have a positive impact on your health, and the health of our planet.  You know you can feel amazing and energized by eating a plant based diet.

But still.  You have the question, IS my plant-based diet meeting my nutritional needs? Maybe you have seen your Medical Doctor and had your B12 checked.  Maybe you intuitively know that must be more that you can look at to assess your plant based diet.  Well, there is.

Plant Based Panel (aka the Vegan and Vegetarian Panel)

Complete blood count with differential

Looking at the size and shape of your red blood cells, as well as the numbers and health of your white blood cells.  Essential for identifying anemia associated with low iron, low B12, or low folate. 

Vitamin B12

The most well known nutrient deficiency in vegans.  And for good cause.  Low levels can cause long term nervous system damage and increase the risk of strokes and heart disease.

Vitamin D (25-OH)

A major health concern for Canadians, low levels of vitamin D are associated with osteoporosis, bone pain (including low back pain), increased incidence of colds and flus and long term risks of cancer.  Dairy products are supplemented with vitamin D, and many supplements are not vegan friendly, leading to potentially higher rates of deficiency in people eating a plant based diet.

Ferritin

The storage form of iron, low ferritin levels can identify iron deficient anemia.  Levels in vegans and vegetarians may be normal, but lower than the optimal range for energy production. 

Total iron (TIBC)

Ferritin provides only a partial picture of iron levels.  To have a comprehensive understanding of iron status the TIBC test is recommended.  This helps you to understand how well your body is binding to, and using iron. 

Creatinine

A by product of the breakdown of muscles, people eating an exclusively plant based diet often have lower than average levels of creatinine.  However, very low levels can indicate that protein in the diet may not be sufficient.  For this test to be accurate you should not do any intense physical exercise for at least 3 days prior to testing.

Albumin

Another measure of protein status, low levels of albumin can indicate that a person is not getting enough protein in their diet.  Other conditions can cause low albumin, so this test is done with basic liver and kidney function tests.

Liver function tests (ALT and AST)

Essential for detoxification and the maintenance of good health, a liver function panel is recommended for everyone, regardless of their diet.

Lipid profile

While plant based diets are naturally low in artery clogging saturated fats, some people have a genetic tendency towards high cholesterol levels.  So even with a plant based diet, lipid (cholesterol) screening is recommended every few years.

Getting the Panel

I offer the Plant Based Panel at both of my Toronto clinic locations. It can be done during the first visit, or during any follow up visit. I use LifeLabs to perform the blood draw and results are typically back within a week. As a Naturopathic Doctor my laboratory tests are not covered by OHIP, but they may be covered by your private health insurance plan. If you have questions, or want to book in and get your levels checked, just get in touch!

Hormones and Hair Loss

One of my favourite/ least favourite stories to tell is how I became a Naturopathic Doctor.  I was in my late teens, finishing my last year of high school, when I began losing my hair.  What was happening to my thick full hair?? It was falling out more and more, but my doctors assured me I “still had lots of hair”, as if that was what mattered.  I was not taken seriously – whether because I was a teen girl, or because my doctors didn’t see how much hair I was losing every day, it didn’t matter.  My hair loss was destroying my self confidence and I was convinced it meant something was wrong.

A Familiar Story

Of course, it did mean something was wrong.  For myself, it was a combination of low iron (which I talk about as a root cause of hair loss) and significant stress.  And this loss of trust in the conventional medical community led me to change my plans from becoming a Medical Doctor to becoming a Naturopathic Doctor.

I’d like to think my story is unique.  But I’ve come to see that it is not.  Many women (and teen girls) come to my practice with similar stories.  Being dismissed and told that their hair loss is not a significant symptom.  Being told that it is normal.  Or having little to no testing done to identify the underlying cause of hair loss. 

I may not be able to help all of the millions of women who experience hair loss, but I hope by sharing my story, and some of my expertise, that I may be able to impact some. 

Hormones and Hair Loss

Hair loss can happen to a woman at any age, and while it may be more common as we get older, that doesn’t mean that it is a normal occurrence at any age.  Keep in mind – common is not the same as normal!  In this article I’m going to focus on the hormonal causes of hair loss, some of the most common causes I see in my practice.  In order to properly diagnose your hair loss, be sure to use the Hair Loss Lab Testing Checklist and get to the root cause. 

Thyroid Imbalances

Your thyroid is a small but mighty gland located in your neck, near your voice box.  The primary role of the thyroid is to encourage energy production by the body.  When the thyroid isn’t functioning optimally, there can be consequences throughout the body, including the hair.  Hair loss can occur with too little thyroid hormone (hypothyroidism) or too much (hyperthyroidism).  A condition known as alopecia areata is also linked to autoimmune thyroid disease, or Hashimoto’s thyroiditis

Conventional testing for thyroid function is not always adequate to identify an underlying thyroid condition.  If you suspect your thyroid may be contributing to your hair loss, get a comprehensive thyroid panel completed with your Naturopathic Doctor, functional medicine doctor or MD.  This test will look beyond TSH and test for free T3, free T4 and thyroid antibodies. 

Testosterone Overload

One of the most common causes of hair loss in women and men, high levels of testosterone can lead to hair loss, especially at the frontal hairline and the top of the head.  While typically thought of as a man’s hormone, women produce testosterone as well.  The real issue isn’t testosterone specifically, but a metabolite of testosterone called dihydrotestosterone, or DHT.  This form of testosterone is much more powerful than regular testosterone and binds strongly to hair follicles on the scalp, face, back and chest – leading to hair loss on the scalp, and acne on the face, back and chest. 

Many women can have lab testing for testosterone that looks normal, but DHT levels may still be high.  It is important to have both these hormones tested, especially if you have other signs of high androgens such as acne or irregular periods, or have been diagnosed with PCOS

Low Progesterone

Progesterone is a damn important hormone.  The natural balancer to both estrogen and testosterone, many hormonal imbalances are a result of low progesterone.  Progesterone is able to block testosterone from accessing receptors, preventing it from leading to hair loss.  Progesterone is also the reason women’s hair grows so thick and healthy during pregnancy! 

The three times in a woman’s life when low progesterone are most common are:

  1. If she is using the birth control pill.  On the pill you do not ovulate, and do not produce progesterone (the synthetic progestins in the pill are not the same thing)
  2. If she has PCOS and does not ovulate
  3. As she ages.  Progesterone production drops through your 30s and many women in their 40s are not making enough to balance their estrogen and testosterone levels.  Women in menopause make hardly any progesterone at all. 

Stress is another common cause of progesterone deficiency, as the body will steal all the available progesterone to make cortisol, our body’s main stress hormone. 

Insulin and Blood Sugar Imbalances

No hormone acts on the body in isolation.  They all influence each other.  Insulin, the hormone produced to encourage our cells to take up sugar and regulate the levels of sugar in our blood, can have an impact on hair loss when it is imbalanced.

When your diet is too high in refined or processed carbohydrates, your cells can become resistant to insulin, causing higher circulating levels of blood sugar.  When this occurs your ovaries can become resistant as well, an imbalance which disrupts healthy ovulation and causes your ovaries to produce more testosterone and DHT. 

Stress and Cortisol

You may pull your hair out when you are stressed, or stress may cause it to fall out.  Stress can cause increased or decreased cortisol levels, both of which can contribute to hair loss.  Excessive stress can also cause your hair to enter its telogen, or hair fall phase, prematurely.  This will often result in hair loss 2-3 months after the stressful event. 

High cortisol will also deplete progesterone and allow for more testosterone to bind to hair follicles, which can further exacerbate hair loss.  If you have significant stress, consider what changes need to be made to help lessen your stress, and explore whether cortisol testing may help to reverse and resolve your hair loss.

Stopping Hair Loss

Understanding the hormonal causes of hair loss for women is just the first step.  To get to the root cause of your hair loss comprehensive testing is almost always necessary.  The problem is that many doctors don’t take hair loss seriously (I know from my personal experience!).  You may need to pay out of pocket to get the level of testing that you need, but in the end, that knowledge can help you put an end to your hair loss and allow you to regain not only your hair, but balance your hormones and give you your quality of life back.

Selected References

Ohnemus U, Uenalan M, Inzunza J, Gustafsson JA, Paus R. The hair follicle as an estrogen target and source. Endoc Rev. 206;27(6):677-706. https://www.ncbi.nlm.nih.gov/pubmed/16877675

Ohnemus U, Uenalan M, Inzunza J, Gustafsson JA, Paus R. The hair follicle as an estrogen target and source. Endoc Rev. 206;27(6):677-706. https://www.ncbi.nlm.nih.gov/pubmed/16877675

Randall VA. Androgens and hair growth. Dermatol Ther. 2008;21(5):314-28. https://www.ncbi.nlm.nih.gov/pubmed/18844710

Randall VA. Hormonal regulation of hair follicles exhibits a biological paradox. Semin Cell Dev Biol. 2007;18(2):274-85. https://www.ncbi.nlm.nih.gov/pubmed/17379547

Levy LL, Emer JJ. Female pattern alopecia: current perspectives. Int J Womens Health. 2013;5:541-556. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3769411/

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem. 

Banishing Breast Tenderness

A woman’s relationship with her breasts can be… complicated.  I should know. I had comic book heroine sized breasts up until a breast reduction after weaning my youngest child.  At that time breast tenderness was just a part of my day-to-day life.  That experience has given me a lot of compassion for women who experience breast pain.  This article is what I am giving back – hope for those women who suffer with pain, and a plan to overcome it.  Take back your ta-tas. 

Breast Tenderness Types

There are typically two types of breast pain – cyclical and noncyclical.  Cyclical breast pain is associated with your period, most often starting a few days (to weeks) before your period and stopping during or just after your period ends. 

Noncyclical pain doesn’t happen just around your period but can happen at any time.  It can be caused by pregnancy, breastfeeding, trauma or injury to the breast, pain from the muscles around the breast, or simply from having large breasts.  It can also be caused by medications, including birth control pills, antibiotics, and antidepressants. 

Most of this article will talk about how to overcome cyclical pain, but women with noncyclical pain can benefit from following these recommendations as well.

Is it Breast Cancer??

No.  It mostly likely is not breast cancer.  Breast pain is not typically linked to breast cancer, and having breast pain does not put you at higher risk of developing breast cancer. 

But don’t hesitate to see your doctor for a second opinion and a breast exam.  Especially if you have symptoms like heat in a specific area of your breast, a fixed/ non-moving breast lump, or changes to your skin on your breast. 

Why Do My Breasts Hurt?

The most common cause of breast pain is your hormones.  Specifically a condition known as estrogen dominance.  Estrogen is the hormone that causes breast tissue to develop in puberty, and throughout our adult lives our breasts continue to respond to estrogen stimulation.  During the week before your period estrogen and progesterone levels can become imbalanced, leading to breast pain.  This is worsened by an overburden of estrogen in our bodies, which we’ll discuss in a moment.  

Breast pain can also be more common in women who have fibrocystic breasts.  As women age her breast tissue is replaced by fat (a process known as involution).  This leads to the formation of breast cysts and fibrous tissue – and a more lumpy breast texture.  Fibrocystic breasts don’t always cause pain, but they can.  Especially as these lumps get bigger leading up to your period. 

Banishing Breast Pain: An Empowered Woman’s Guide

Experiencing breast pain is not a normal part of a woman’s life.  If you have tender breasts, try to understand why your body has developed this symptom – is it a hormonal imbalance? Are you stressed? Are you tired? Are you taking time for self-care? Is your diet and exercise up to your standards?  Once you’ve taken stock of your life, put the recommendations below into action for 2-3 months and see how much of an impact you can have on your health – you’ll be amazed at how powerful you are. 

1.Eliminate Estrogen Dominance

I’ve talked extensively about estrogen dominance elsewhere but it really is an incredibly common concern for women.  Estrogen is an important hormone for women’s health, but our levels are far higher than our systems can manage.  Increased estrogen production in our bodies from excess body fat, stress and poor diets, combined with estrogen-like chemicals in the environment (known as xenoestrogens), and terrible detoxification and elimination from alcohol consumption, low fiber diets and insufficient vegetable intake has left women living a veritable estrogen soup.   

The consequences of estrogen dominance are huge.  PMS, mood changes, low libido, sugar cravings, brain fog, crazy periods, and breast tenderness are common.  So what should we do about it?

Eliminating estrogen dominance is a huge issue in women’s health.  But luckily there are some action steps you can take now to address this hormone imbalance, and reduce your breast pain.

  • Reduce stress
  • Eat a high fiber diet – consider having 2 tbsp of ground flax seeds per day in addition to lots of healthy leafy green and rainbow vegetables
  • Eliminate excess body fat – a lot of women don’t realize that fat cells can make estrogen, so if you’re more than 15 lbs overweight, consider talking to your Naturopathic Doctor about how to achieve your healthiest body weight
  • Avoid plastics, pesticides and other sources of environmental estrogens.  Drink water and eat out of non-plastic containers.  And never microwave plastic!
  • Limit intake of dairy products

2. Detox Like a Champ

Reducing how much estrogen your body makes/ intakes is an excellent first step in banishing breast pain.  Now we move to the next step – supporting your liver in detoxifying that estrogen!  Your liver needs to take all the estrogen circulating in your body and convert it into a compound that you can eliminate (we’ll cover that in the next step!)  For effective detoxification we need to make sure we have adequate nutrients, especially the B vitamins and trace minerals.  We also want to ensure we’re not overwhelming our liver with excess alcohol intake, pain medications or other pharmaceutical medications.  One of the best things you can do to support your liver is not drink alcohol.  Risky alcohol consumption for women is anything more than one drink per day. 

To support your liver, be sure to eat lots of leafy green vegetables.  Bitter greens like kale, dandelion greens, endive or chicory are especially helpful for the liver.  You can also consider liver supportive supplements like dandelion root, turmeric, artichoke, greater celandine and milk thistle to up your detox game.

3. Master Your BMs

You can be a super-star detoxifier, but if you aren’t having daily bowel movements you are not going to be able to balance your hormones are reduce your breast pain.  Our excess hormones are eliminated in our poop – if you aren’t having healthy daily poops you are going to end up recycling a lot of that estrogen and having to detoxify it all over again.

Best bets for mastering your BMs are a high fiber diet, a regular intake of healthy probiotic bacteria – either through supplements or fermented foods, and potentially a magnesium supplement.  Magnesium citrate or bisglycinate can help to get you regular while you focus on improving your diet.  Studies suggest between 200-600mg of magnesium can help by drawing more water into your stool and promoting regular BMs.

4. Target Your Diet

Inflammation can be a major contributing factor to pain in our bodies, and our breasts are no exception.  By reducing inflammation in our diet we can significantly improve breast pain.

The ideal diet for breast pain is pretty much what you’d expect.  Eat more vegetables, lots of healthy plant based proteins, fish, leafy greens and healthy fats.  Limit or eliminate sugar, alcohol and dairy.  Coffee, especially at high amounts (more than 1-2 cups per day) can also contribute to inflammation and pain, so check in with yourself and see if you’re overdoing the drip. 

Adding in healthy fats and phytoestrogens will also help with hormone balance.  Flax seeds are a superstar for this – they contain omega 3 fats, healthy fiber and phytoestrogen lignans which bind to estrogen receptors and prevent other stronger estrogens from binding.  Flaxseeds – the overachiever of the seed family. 

5. Support with Supplements

You cannot supplement your way out of a terrible diet.  But there are absolutely some supplements than can help reduce breast pain, especially over the first few months while you are making the lifestyle and diet changes that will help you remain pain-free. 

EPO for breast pain

Vitamin E has been found in studies to reduce cyclic breast pain, especially when combined with evening primrose oil (EPO).  A fat-soluble nutrient, vitamin E reduces inflammation and acts as an antioxidant in our cells.  EPO is often used as a source of pregnenolone, the precursor hormone to progesterone, which is essential to balance the effects of estrogen in the body.  600IU of vitamin E with 2-3 grams of EPO is a typical dose. 

B vitamins are necessary for liver detoxification and can be taken as a simple B complex supplement.  Vegans and vegetarians in particular should be considering a B complex containing vitamin B12.

Iodine is another nutrient essential for breast health and low levels have been associated with the development of lumpy fibrocystic breasts.  Rates of iodine deficiency are incredibly common, and you should discuss with your ND whether or not you should test your levels.  A multivitamin supplement will provide you with some essential iodine, or seaweed snacks are a great food source. 

Chaste tree, or Vitex agnus-castus, is hands-down my favourite botanical supplement for cyclic breast pain.  Also used to reduce painful periods and PMS mood changes, chaste tree can be a game-changer for women with miserable premenstrual symptoms.  Talk to your ND to ensure this is a good choice for you. 

Taking Back Your Ta-Tas

My philosophy of women’s health is “No More Meh”.  You don’t have to accept symptoms of breast tenderness, mood changes and low libido.  You don’t have to feel exhausted and overwhelmed.  You are a force of nature.  You are a damn goddess.  Own it. 

If you want to work together, drop me a line via email or Facebook or follow me on Instagram. I’d love to meet you. 

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem. 

Select References

Pruthi S, Wahner-Roedler DL, Torkelson CJ, et al. Vitamin E and evening primrose oil for management of cyclical mastalgia: a randomized pilot study. Altern Med Rev. 2010;15(1):59-67. https://www.ncbi.nlm.nih.gov/pubmed/20359269

Mirghafourvand M, Mohammad-Alizadeh-Charandabi S, Ahmadpour P, Javadzadeh Y. Effects of Vitex agnus and flaxseed on cyclic mastalgia: a randomized controlled trial. Complement Ther Med. 2016;24:90-95. https://www.ncbi.nlm.nih.gov/pubmed/26860808