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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

PMS or PMDD?

Premenstrual syndrome (PMS) is a many-headed beast – with over 150 different symptoms attributed to PMS, many women find the week before their period to be a challenging time.

But what about those women who are completely destroyed by their PMS? Who suffer with severe mood changes, insomnia and fatigue? For those women, they may be suffering from PMDD – premenstrual dysphoric disorder.

A Diagnosis of PMDD

PMDD is classified as a depressive disorder. It is not the same as clinical depression as it occurs with a very specific timing – during the second half of the menstrual cycle, after ovulation, and it resolves within a few days of starting your period.

PMDD causes a lot of distress and significantly impacts a woman’s ability to function and to maintain her quality of life. Between 2-6% of women experience PMDD, but many of them don’t seek treatment and instead suffer each month with severe symptoms.

PMDD is different from PMS in the severity of symptoms and the consequences of the mood changes.   The diagnosis is made by using symptom tracking reports and needs to meet the following criteria:

Treatment of PMDD

The conventional approach to treating PMDD results in most women being given one of two options: the birth control pill, or an antidepressant. While these treatments may be effective for some women, many more women are seeking a more natural, empowered approach to managing their PMDD.

Natural Approaches to PMDD

In my article on Ten Natural Treatments for PMS I discuss the lifestyle and diet for managing PMS. I suggest all women with PMDD also follow those recommendations. But for PMDD I tend to take a more aggressive approach – the symptoms are often severe enough to warrant a very targeted and bold plan.

Vitamin B6

Used in both PMS and PMDD, vitamin B6 is necessary for the production of cortisol, progesterone and serotonin – all hormones involved in PMS and PMDD. Taking high (orthomolecular) doses of vitamin B6 can be helpful at reducing symptoms of PMS and PMDD. Vitamin B6 is usually taken all month long, but higher doses can be used in the second half of the cycle if needed.

Calcium

Calcium has been found in studies to reduce a wide variety of symptoms associated with PMS. While I don’t find it to be useful on its own, in a robust protocol calcium can play a role in reducing both the mood and physical symptoms of PMS and PMDD.

L-tryptophan and 5-HTP

Two supplements that can increase the production of serotonin in the body, L-tryptophan and 5-HTP, show a lot of promise in the treatment of PMDD. Supporting the serotonin system in women has been one of the most effective means of treating PMDD. L-tryptophan and 5-HTP are the direct precursors of serotonin and can significantly reduce mood symptoms of PMDD. These supplements are not taken together, and should not be combined with other antidepressants. Use under the guidance of a knowledgeable and experienced Naturopathic Doctor.

St. John’s Wort

One of the most commonly used botanical medicines, St. John’s Wort is an excellent treatment for women with PMDD. Acting on the serotonin system in the body, St. John’s Wort can reduce depressive symptoms of PMDD and improve mood. It can be taken all month long, or just during the second half of the menstrual cycle.

Chaste Berry

Chaste berry (chaste tree, Vitex agnus-castus), which I also discussed in the PMS article, has been found to be effective for PMDD. Chaste berry can reduce anger, irritability, anxiety, mood swings, and physical symptoms associated with PMS and PMDD. My experience is that it can be moderately effective for PMDD, but often additional treatments are needed to help women feel considerably better.

IV Micronutrient Therapy

One treatment that I have found to drastically improve PMS and PMDD symptoms in women is IV micronutrient therapy (IVMT). IVMT allows us to administer doses of vitamins (like B6, calcium and magnesium) at higher doses than you would be able to take orally. IV therapy also provides an abundance of nutrients necessary for detoxification of hormones – and reducing the hormone burden in the body can greatly improve symptoms of PMDD. Not every woman is a candidate for IVMT, but talk to your Naturopath to find out if you are.

Bio-Identical Progesterone

While we don’t know exactly what causes PMS and PMDD, one suspect in this mystery is an imbalance of estrogen and progesterone – often called estrogen dominance. When progesterone levels are unstable, or low, and estrogen levels are high, PMS and PMDD depression and mood swings can result. For some women, especially those in their 40s, bio-identical progesterone can be a lifesaver. Your ND will give you a questionnaire to identify a possible progesterone imbalance, and may also recommend hormone testing.

Empowering Your Journey

If you are interested in learning more about how to manage your PMDD, I suggest working with a qualified Naturopathic Doctor who can guide you on this journey.  PMDD is too severe, and too complex to try and piece together a treatment on your own.  Working with an ND who can guide and support you on this journey may be the best decision you make for your health and your sanity.

Select Resources

Comprehensive Gynecology, Seventh Edition. Ed. Lobo R, Gershenson D, Lentz G. 2017; 37, 815-828.

Ferri’s Clinical Advisor. Premenstrual Dysphoric Disorder. Ed. Ferri FF. 2019

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.

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The Empowered Woman’s Guide to HSV

Oh herpes. No one wants you. But with 2/3 of people under age 50 having some form of herpes, a lot of women are dealing with this unwanted guest in their lady garden. And herpes isn’t going anywhere – once you have the herpes virus, you always have the herpes virus. Herpes is one of the types of virus that is able to remain in a hidden state in our bodies (called “latent” infection) and pop out when we least want it to.

Types of Herpes

There are two types of herpes simplex virus – HSV-1 and HSV-2. HSV-1 is the virus associated with most cold sores. HSV-2 is the one associated with genital herpes. However their location doesn’t really matter – you can have HSV-1 on your genitals, and while relatively rare, you can also have HSV-2 around your mouth.

How to Get Herpes

Now no one wants to get herpes, but honestly it is hard to avoid. HSV-1 and -2 are transmitted by physical contact, kissing or sexual intimacy. As one of the most common sexually transmitted infections, exposure rates are very high. To avoid exposure to HSV use condoms or dental dams when having sexual contact, and avoid direct contact during known outbreaks in a partner.

While HSV-2 is commonly transmitted sexually, it can infect the mouth as well through oral sex. Most cases of HSV-1 are contracted during childhood, but can also occur sexually. HSV-1 and -2 can both also be passed along to infants during childbirth.

Symptoms of HSV

Many people recognize the symptoms of cold sores – a watery blister near the lip (or sometimes the nose) or in the mucous membranes of the mouth. As the blister heals it forms a characteristic scab.

But herpes can also be completely silent – many people have HSV infections and never know it. This contributes to the high rates of exposure to HSV – it can be passed on even if no active blisters or sores are present.

Symptoms of an outbreak can also cause some symptoms such as tingling, burning or flu-like symptoms before the blisters appear. It is important to avoid direct contact with a partner during these times (use a condom or dental dam).

The first contact with the virus will cause the primary outbreak – usually with symptoms showing up between 2-21 days after contact. Typically this outbreak is more severe and can last longer than subsequent outbreaks.

Triggering Future Outbreaks

Any number of different triggers can lead to the resurgence of the herpes virus. Things that compromise your immune function – like lack of sleep, stress, poor diet and alcohol consumption are common triggers. Other triggers may be sun exposure, excessive heat, skin irritation or other local infections.

Diagnosing HSV

The best test is a simple swab, done in your doctor’s office soon after the onset of the blisters. It can take up to a week for results to come back, so treatment is often started if the symptoms and appearance are consistent with a herpes infection.

There are blood tests available as well that can be used if HSV is suspected.

An Empowered Approach to Treating HSV

My first step in treating HSV in women is to offer assurance. You are practically a unicorn if you have never had HSV – most people in Canada do have it (and remember, once you’ve had it you always have it). It is a virus like any other and we need to let go of some of the negative connotations around contracting HSV.

Second, there are antiviral medications available that can help to lessen the severity of an outbreak and lower the chances of passing HSV to a partner. While I don’t advocate for on going use of these medications, they can be used judiciously in women who are looking for short term support.

Of course, as a naturopathic doctor, my focus is on empowering women to make choices for their health based on knowledge and informed by science. So I like to emphasize what we, as women, can do to help control HSV and prevent outbreaks.

St. John’s Wort – most commonly known as a treatment for depression, Hypericum perforatum (St. John’s Wort) also has powerful antiviral properties that are effective against herpes viruses. Typically taken at higher doses for 1-2 weeks, then decreasing to a lower or maintenance dose.

Lysine – one of the more well-known treatments for HSV, lysine is an amino acid that helps to stabilize the virus and prevent reactivation. It is most often taken daily to prevent outbreaks. Many doctors also suggest consuming more lysine in the diet, and avoiding arginine – this balance supports the immune system in it’s work. Below you’ll find a list of foods high in lysine (enjoy lots of these!) and foods high in arginine (limit these).

Lemon Balm – topical lemon balm is stellar at soothing and supporting the healing of cold sores and genital herpes. It is applied directly to the lesions once or twice per day during an outbreak.

Coriolus Mushrooms – mushrooms pack one hell of a punch when it comes to optimizing our immune system. Coriolus mushrooms in particular have been found to optimize immune function and support the immune system in it’s battle against viruses. I suggest taking mushrooms regularly to support your immune function.

Empowered Steps

If you are struggling with recurrent HSV outbreaks, or this is your first outbreak, I hope that you feel more knowledgeable after reading this article. As always, I suggest that you work with a qualified Naturopathic Doctor to put together a plan that approaches all aspects of your health, and the health of your lady garden. If you’d like to work with me, I am happily taking new patients in my women’s health focused practice in Toronto. You can book here.

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.

Phytoestrogens: Hormone Balance With Food

Phytoestrogens, or plant-based estrogens, are compounds found in our food that can bind to our estrogen receptors.  While a lot of confusion exists on the impact this has on our hormone health, I’m going to help you understand the amazing balancing effects of phytoestrogens, and tell you why you should consider having more of them in your diet.

Why Phytoestrogens are Important

In our bodies we have three sources for estrogen: the estrogen we make (also known as endogenous estrogen), the estrogen we eat (phytoestrogens) and the estrogen-like compounds we are exposed to in our environment (xenoestrogens).

Each of these estrogens can bind to an estrogen receptor and cause an estrogen-like effect.  The chemical estrogens, or xenoestrogens, from the pesticides, herbicides, personal care products and other chemicals in our body have a much stronger impact than that of our own home-made estrogen.  And the plant estrogens have a much weaker effect.

The Balancing Effects of Estrogen

With many women suffering from conditions of excess estrogen – like fibroids, PCOS, obesity and estrogen dominance as well as estrogen sensitive conditions like endometriosis, fibrocystic breasts and breast cancer – lowering their body burden of estrogen is important.  For women with high estrogen, consuming more very mildly estrogenic phytoestrogens can prevent the negative impact of exposure to their body’s own estrogens as well as the chemical estrogens from the environment.  When you have lots of plant estrogens in your body they occupy the estrogen receptor, causing a very small estrogen-like impact, but most importantly, they prevent other stronger estrogens from binding to that receptor.  This results in an overall lower estrogen state in the body.

Following along so far?  It gets better!

When women are suffering from low estrogen – due to hysterectomy or menopause, phytoestrogens can also be helpful.  When women is no longer producing her own estrogen in optimal amounts, the small amount of an estrogen effect from a phytoestrogen can help to boost her estrogen levels and diminish symptoms of low estrogen like hot flashes, night sweats, insomnia and mood swings.

Food Sources of Phytoestrogens

More than 300 different plants contain phytoestrogens. There are several subclasses of phytoestrogens, some of which are listed below.

Lignans – Vegetables, fruits, nuts, cereals, spices, seeds; especially flax seeds

Isoflavones – Spinach, fruits, clovers, peas, beans; especially soy

Flavones – Beans, green vegetables, fruits, nuts

Chalcones – Licorice root

Diterpenoids – Coffee

Triterpenoids – Licorice root, hops

Coumarins – Cabbage, peas, spinach, licorice, clover

To increase dietary sources of phytoestrogens, consider the following foods:

Flax seeds – the highest food source of phytoestrogens is flax seed and oils. The phytoestrogens in flax seeds are lignans. Lignans have antitumour, antioxidant, and weakly estrogenic and antiestrogenic characteristics. They have been found in studies to decrease vaginal dryness, hot flashes or night sweats in women with low estrogen symptoms.

Soy, edamame, tofu, tempeh – the best known phytoestrogen, soy, when consumed in the diet, is safe for women with symptoms of both high and low estrogen.  For hot flashes and night sweats, women who consume soy tend to have less symptoms than women who do not.  Other research suggests that increasing soy foods in the diet stabilizes bone density, decreases cholesterol levels and has a favourable effect on cardiovascular risk profiles in menopausal women

Beans: soybeans, tempeh, black beans, white beans, kidney beans, lentils, mung beans, coffee

Grains: wheat berry, oats, barley, rice, alfalfa, wheat germ

Seeds and nuts: flaxseed, sesame seeds, fenugreek

Vegetablesyams, carrots

Fruits: apples, pomegranates

Herbs and spices: Mint, licorice root, ginseng, hops, fennel, anise, red clover

Harmonizing Your Hormones

If you are interested in exploring more ways to balance your hormones naturally, book a free 15 minute meet and greet appointment with me to discuss how you can bring harmony to your hormones and fire up your health!

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 PATH To Treating Bacterial Vaginosis

BV, or Bacterial Vaginosis is the most common vaginal infection in women worldwide. With few symptoms, aside from an unpleasant odour, many women are experiencing recurrent BV infections without receiving appropriate treatment.

But no more. Today I will take you on the PATH to treating BV, so that you don’t have to struggle with BV any longer.

Understanding BV

Bacterial vaginosis occurs when the healthy bacteria balance in the vagina is disrupted. With trillions of bacteria colonizing the vaginal tract, when those populations are out of balance the delicate pH of the vagina changes and symptoms can occur.

Unlike yeast infections, bacterial vaginosis typically has fewer symptoms. Not usually associated with pain, itching, irritation or pain with intercourse, bacterial vaginosis has just two main symptoms:

  • a thin whitish discharge
  • a foul “fishy” odour

These symptoms are often worse after a menstrual period or exposure to semen in the vagina – these can alter the pH balance and support the growth of less-than-desirable bacteria in the lady garden.

The most common bacteria involved in BV is Gardnerella vaginalis, but some other bacteria have been implicated as well – including Mycoplasma hominis, Ureaplasma urealyticum and Prevotella bivia…along with many others.

The metabolic activity of these bacteria causes the discharge and the characteristic odour of BV.

While BV may have few symptoms on its own, it can lead to urinary tract infections (UTIs), pelvic inflammatory disease, infertility, candida infections and an increased risk for sexually transmitted infections (STIs).

Diagnosing BV

BV is pretty straightforward to diagnose – and most women can tell you without a doubt if they are experiencing it. To diagnose BV your doctor will use what is called the Amsel Criteria. This can easily be done in office.

The PATH To BV Treatment

Understanding that BV is caused by an imbalance in healthy bacteria is the most important step in treating BV. When I am treating BV, I encourage all women to follow the PATH – four essential steps in treating BV so that it doesn’t keep coming back.

            PROMOTE Healthy Vaginal Flora

The bacteria that live in our lady garden are essential for maintaining a healthy vaginal environment. Their health often depends on our behaviours – so we need to do what we can to support them.

A diet high in sugar can promote the growth of undesirable bacteria. As can a diet low in fiber from plant foods. A lack of fermented foods in the diet can lead to low populations of healthy bacteria as well.

The most important thing we can do to promote healthy vaginal flora is to take a probiotic supplement. Both oral and vaginal probiotics (suppositories and creams) can support and promote a healthy balance of bacteria levels in the vaginal tract. Selecting appropriate strains is important – make sure that any probiotic you choose has adequate amounts of Lactobacillus – at least 10-12 billion per day for at least 6 months is what is recommended.

            AVOID Triggers of Vaginal Infection

Just as we need to promote healthy bacteria levels, we also have to avoid those things that promote infection.

Bacteria imbalances are more common in women using the birth control pill – both due to the high doses of estrogen and the less frequent condom use in women on the pill. Antibiotic use will also alter bacteria balance and increase the incidence of BV.

Douching and wearing non-cotton based underwear will also increase the risk for BV and should be avoided, especially during active treatment for BV.

            TREAT Overgrowth of Bacteria and Normalize pH

The normal pH of the lady garden is somewhere between 3.8-4.5 – a nice acidic environment.   The pH is maintained in this range by the healthy bacteria – mostly Lactobacillus that colonize the vaginal tract. In BV the pH is elevated above 4.5 – sometimes as high as 7.0! Restoring the healthy pH is essential for resolving the symptoms of BV and preventing recurrence.

The best way to normalize the pH is with the use of boric acid suppositories. Having a similar pH to the healthy vaginal tract, boric acid can restore the pH and, when combined with healthy bacteria supplementation, treat BV very effectively.

Your ND will help you to understand the protocol for use of boric acid suppositories and you can have a local compounding pharmacist make the capsules just for you.

HEAL Inflamed or Irritated Tissues

For the majority of women bacterial vaginosis is not associated with significant irritation or inflammation. If you have redness or swelling of your vulva, discuss with your Naturopath whether you may also have a candida (yeast) infection.

For women using the boric acid suppositories to restore healthy pH balance, there is a small chance of irritation. If this occurs a topical vitamin E gel is highly effective for decreasing irritation and healing the tissues.

Taking the PATH

Now that you have a roadmap to treating BV, I hope you will always consider the PATH when you are managing your BV. This approach has helped countless women in my practice overcome their bacterial vaginosis, and I hope it will help you too. If you’d like to work together and allow me to be a guide on your PATH, don’t hesitate to book an appointment today!

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 Resources

Cribby S, Taylor M, Reid G. Vaginal Microbiota and the Use of Probiotics. Interdiscip Perspect Infect Dis. 2008 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2662373/

 

Estrogen Dominance

Estrogen dominance – it’s the most common hormone imbalance for women in their 40s and has symptoms that will sound familiar to many of you – but many women don’t realize this imbalance even exists. So let’s shed some light on this imbalance so that no woman has to suffer in silence anymore.

Women’s Hormones 101

To understand estrogen dominance, first we have to start with a quick refresher on our two primary female hormones – estrogen and progesterone.

Estrogen is the main hormone in the first half of our menstrual cycle and causes the lining of the uterus to thicken. Estrogen is produced by the ovaries, but also by fat cells. Estrogen levels can also be raised by exposure to xenoestrogens – compounds in our environment that look like estrogen and are able to bind to estrogen receptors.

Progesterone is the main hormone in the second half of our cycle, and supports implantation and pregnancy. Increases in progesterone signal the body to stop making so much estrogen. Progesterone is made almost completely by the ovaries, but small amounts can be made in the adrenal glands as well.

WTF is Estrogen Dominance?

Women are born with all their eggs – so the eggs we ovulate each month have been along for the entire ride of our lives. As our eggs age their quality decreases – this has two major impacts that set us up for estrogen dominance.

  1. Older eggs take longer to mature – an older egg may be slower to reach maturity – this causes the brain to produce higher levels of FSH (follicle stimulating hormone) to attempt to mature the egg. The higher the FSH, the more follicles that are stimulated and the higher the estrogen production.

While many women believe estrogen levels decline in our 40s, the opposite is in fact true. Estrogen levels only significantly decline at menopause.

  1. Older eggs produce less progesterone – one of the main reasons our fertility drops off with age is that our older eggs make less progesterone. This drop in progesterone production can impact much more than our fertility – it is also the reason that PMS is more intense in our 40s and sets the stage for estrogen dominance.

Estrogen dominance is the state where estrogen levels are not balanced by progesterone levels – too high estrogen and too low progesterone. And this is where the chaos begins…

Symptoms of Estrogen Dominance

Not sure yet if you are dealing with estrogen dominance? Read these symptoms and see if they ring true for you.

  • Anxiety
  • Depression
  • Mood swings
  • Irritability
  • Insomnia
  • Bloating
  • Carbohydrate and sugar cravings
  • Difficulty concentrating
  • Brain fog
  • Weight gain or difficulty losing weight
  • Frequent yeast infections
  • Joint pain or inflammation
  • Heavy or irregular periods (longer or shorter cycles)
  • More PMS
  • Headaches and migraines premenstrually
  • Swelling and water retention
  • Lack of sex drive/ low libido
  • Breast tenderness or swelling
  • Uterine fibroids

Why Haven’t I Heard of Estrogen Dominance?

Unfortunately a woman who presents to her doctor with the symptoms listed above will often be dismissed (It’s just stress! You’re getting older – it happens), be given an antidepressant, be put on the birth control pill (to “regulate” hormones) or told to relax, lose weight, or get counseling. Very rarely will a doctor delve into the hormonal fluctuations with hormone testing, or even discuss the likely imbalances that occur in our 40s.

Testing for Estrogen Dominance

For some women the symptoms are so clear that testing may not be necessary. But for most women, hormone testing is recommended to get a clear picture of what her individual hormone balance is, and to develop a plan that will help to restore her personal hormone harmony.

DUTCH test, hormone testing,hormone test, women's hormones, hormone healthHormone testing can be done via blood tests, saliva tests or the DUTCH urine test. I go into greater detail on hormone testing in this article: Hormone Testing Options

For any hormone test that is done, the most important thing to look for is balance. Many women are dismissed as “normal” when their hormone values are all within the normal limits. But more important than the actual value of the hormones, is the balance between the hormones. If estrogen is normal but progesterone is very low, estrogen dominance occurs. If estrogen is high but progesterone is normal, estrogen dominance occurs. You need to ensure that whoever is interpreting your tests with you has a great deal of knowledge on hormone balance.

It’s Not Just About Your Periods

As you can see from the list of symptoms above, estrogen dominance impacts a lot more than just our periods and our PMS. All our hormones function in harmony with each other – and when one hormone is imbalanced, there can be significant ripple effects on the other hormones. Below are just a few:

Estrogen dominance worsens hypothyroid – high levels of estrogen lead to an increased clearance of our energizing thyroid hormones – this can lead to symptoms of hypothyroidism (fatigue, brain fog, weight gain, hair loss) or worsen symptoms in women who have this condition

Estrogen dominance is worsened by stress – increased production of cortisol, as occurs during times of stress, lowers progesterone levels. Cortisol also competes with progesterone for receptors – which can cause symptoms of estrogen dominance even when progesterone levels are adequate. This can worsen symptoms of stress like irritability, decreased coping, fatigue and overwhelm.

Treatment of Estrogen Dominance

When we are treating estrogen dominance we have two main goals in mind – lower the estrogen and increase the progesterone.

Lowering Estrogen

  1. Decrease exposure to xenoestrogens – Commonly found in plastics, personal care products and household cleaners, avoiding exposure to the synthetic estrogens that are abundant in our environment is an essential first step.
  2. Support estrogen detoxification – B vitamins, probiotics, brassica vegetables, DIM and 13C are all essential for allowing your body to clear the estrogen and restore balance to your body. Your Naturopathic Doctor will help you to determine what the best choices are for you – but starting with a B complex supplement, a probiotic and choosing more foods in the cabbage family (broccoli, cauliflower, kale, cabbage, Brussels sprouts) is recommended.

Increasing Progesterone

  1. Make sure you can make it – essential nutrients for the production of progesterone include B vitamins (especially vitamin B6), and magnesium. So ensuring you have an abundance of these in your diet, or in supplement form, is important for overcoming estrogen dominance.
  2. Bioidentical progesterone cream – sometimes the only way to overcome estrogen dominance is to add back some of what we need – progesterone. Available in Canada as a prescription from your Naturopath, bioidentical progesterone provides your body with the progesterone you no longer make as easily. It can be a life changing treatment for many women in their 40s.

Harmonizing Hormones

Our 40s as women can be a tumultuous time – raising children, achieving career success, supporting spouses, aging parents – any number of significant life events. But our hormones don’t need to be tumultuous. We can support our bodies and our minds by focusing on achieving our individual hormone harmony. If you want to discuss more about your hormone health, book a free meet and greet or an appointment today.

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.

PCOS and Mental Health

Polycystic ovarian syndrome is the most common hormone imbalance in women and yet very few people are talking about how significantly this imbalance is impacting women’s lives.

PCOS can impact any woman, at any age – from puberty to perimenopause, and in addition to the typical symptoms of irregular or absent periods, acne, facial hair growth and scalp hair loss, there can also be an increased incidence of mental health concerns.

PCOS and Depression

It has been my experience in practice that women with PCOS often have signs of depression – many of them due to the effects the symptoms of PCOS have on their body image. Researchers have found that nearly ¼ of women with PCOS have depression and they too suggest it may be linked to the “emotionally distressing” symptoms associated with PCOS, rather than the underlying hormone imbalance itself.

PCOS and Anxiety

Rates of anxiety are also higher in women with PCOS, with 11.5% of women in one study having both diagnoses (compared to an average 9% in the general female population).

Anxiety may be associated both with the physical symptoms of PCOS, but potentially may also stem from the hormone imbalances, such as low progesterone, that are common in PCOS. Progesterone is an anxiety-lowering hormone and low levels of progesterone occur when there is no ovulation – such as in PCOS.

PCOS and ADHD

Another interesting finding from the 2018 study on PCOS and mental health – women who have PCOS have an increased risk of having children who are diagnosed with ADHD (attention deficit hyperactivity disorder) or an autism spectrum disorder. The researchers suggest that it may be due to higher circulating androgens during development.

Support for PCOS and Mental Health

Focusing on whole body health, rather than just the visible symptoms of PCOS is important for all women with PCOS. While most women will want to focus on clearing acne and decreasing body weight, we must look at women as a complex entity of interlacing systems – ladies, we are all unicorns – we need to be treated individually and with attention to our specific wants and needs. Our mental and physical health are one and the same, and we should seek care from health care providers who recognize that.

Your Naturopathic Doctor can help you to put together a plan that focuses on your diet, lifestyle, obstacles to health, hormonal imbalances and mental and spiritual health.  Looking at your life and health as a whole, rather than individual symptoms to be managed, your ND works with you to achieve optimal health – in all areas of your life.

Select References

Thomas R Berni Christopher L Morgan Ellen R Berni D Aled Rees.  Polycystic ovary syndrome is associated with adverse mental health and neurodevelopment outcomes.  The Journal of Clinical Endocrinology & Metabolism, jc.2017-02667

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.

 

PCOS and Hair Loss

My personal experience with hair loss in my early 20s has given me a keen passion to support women with hair loss of any cause. In other articles I’ve discussed the Root Causes of Female Hair Loss and Alopecia Areata but in this article I’m discussing the hormonal hair loss associated with PCOS.

PCOS: Hormone Havoc

In polycystic ovarian syndrome (PCOS) the ovaries do not respond appropriately to hormonal cues from the brain (the pituitary gland to be precise), resulting in the formation of cysts in the ovaries.

These cysts are actually unsuccessfully ovulated follicles – in normal ovulation the follicle ruptures and releases an egg. But in PCOS the follicle continues to grow and becomes a cyst.

Because the follicle does not release the egg, and continues to grow, it also continues to release hormones – mostly estrogen and testosterone. And it is this hormonal havoc that can lead to hair loss.

Testosterone and Hair Loss

High levels of testosterone are known to contribute to hair loss, and women with PCOS often have elevated levels of testosterone and other androgens (including dihydrotestosterone – a super powerful form of testosterone).

The testosterone can bind to receptors in the scalp hair follicles, stimulating hair loss in a male pattern – typically hair is lost at the front of the hair line, and at the very top of the head. It’s usually in a diffuse pattern – meaning the hair falls out all over rather than in patches.

The low progesterone that occurs in PCOS (progesterone is only produced after ovulation – no ovulation, no progesterone) also binds to those same hormone receptors in the hair follicle – preventing hair loss from occurring. So the balance of high (or even normal) testosterone and little to no progesterone causes the hair loss we see in PCOS.

Treating PCOS Hair Loss

The goal of treatment in hair loss associated with PCOS is to get you ovulating again. The balance of hormones in a healthy menstrual cycle should prevent hair loss from occurring. In the early stages of treatment we may also use treatments like saw palmetto, spearmint, berberine or inositol to decrease the testosterone levels.

As with all treatments for hair loss, the benefits take time to become apparent. The life cycle of the hair is three months – any hairs that have already been triggered by testosterone to fall out will do so for the first few months. So don’t give up on your treatment if you don’t see a benefit right away. The work you do now will benefit future you.

If you have any questions about your hair loss – whether it is associated with PCOS or any other condition, book a free 15 minute consultation so we can talk.

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.

PCOS & Berberine

While your medical doctor may not have heard of it, the functional and naturopathic medicine community is raving about berberine for polycystic ovarian syndrome (PCOS). And if you haven’t heard about it – you are about to go to school on WHY berberine may be exactly the treatment you have been looking for.

What is Berberine?

Berberine is a compound (technically a quaternary ammonium salt – damn! science!) found in several plants – most notably barberry, Oregon grape and goldenseal.  It has been used as a medicine in Traditional Chinese Medicine for over 5000 years.

Berberine Improves Insulin Responsiveness

One of the key findings in many women with PCOS is a poor response to insulin. When the cells (including those of the ovaries) stop responding to insulin, energy goes down, weight gain goes up and many of the hormone imbalances associated with PCOS show up.

One of the most common prescription treatments for PCOS is metformin, a drug that improves insulin response. But studies have found that berberine is able to do this too – and maybe even a bit better than metformin!

Berberine stimulates cells to take up glucose, so blood sugar and insulin levels drop. This can result in ovulation for women with PCOS. One study also found that the women taking berberine lost more weight than the women on metformin. Win-win!

Berberine Lowers Testosterone

The elevated testosterone associated with PCOS is the one hormone imbalance most women want addressed quickly. Elevated testosterone leads to the acne, head hair loss, chin and upper lip hair growth that women despise. Studies have demonstrated that berberine can lower testosterone levels and speed the resolution of these symptoms.

Berberine Benefits Your Gut

Berberine is not just great for your ovaries, but it’s great for your gut too. Berberine has been used for generations to treat symptoms of gas, bloating, constipation and diarrhea. Now we understand that it does this by helping increase the production of short chain fatty acids and supporting the healthy bacteria (probiotics) in our guts. Healthy bacteria help us to eliminate estrogen – minimizing the potential for estrogen dominace – another common hormone imbalance in PCOS.

Berberine Loves Your Liver

Your liver is essential in hormone balance. Berberine has been found in studies to increase the production of sex hormone binding globulin (that’s a mouthful…) or SHBG that binds to testosterone and makes it unavailable for use in your body.

Berberine has also been found to lower liver enzymes in non-alcoholic fatty liver disease, a condition that is commonly found in women who are overweight and have PCOS.

Berberine Benefits Fertility

Whether you are trying to get pregnant or just balance your hormones, it is reassuring to know that berberine can improve ovulation and pregnancy rates in women with PCOS. In women with PCOS undergoing IVF procedures, those who took berberine (no matter whether they were normal weight or overweight) had higher pregnancy rates than women using metformin or a placebo.

Berberine Boosts Weight and Fat Loss

Not every woman with PCOS is overweight (I talk about that more in the PCOS Types article), but if you are even mildly overweight berberine can help you to shed some unwanted fat.

Berberine has been found in multiple studies to support weight loss and to help target fat loss from the midsection of the body. Berberine helps to lower the production of our hunger hormone, leptin – a hormone that stimulates our appetite. Women with PCOS and women who are overweight often have abnormal levels of leptin.

Building on Berberine

Berberine is an excellent option for many women with PCOS. It can be the cornerstone for PCOS treatment and help you to achieve your dreams of hormone harmony.

Discuss with your Naturopathic Doctor if berberine is the best bet for you.  It may be used in combination with other natural treatment options, diet and lifestyle changes to improve your health and hormones, naturally.

Select Resources

Toronto Naturopath, Dr. Lisa Watson discusses the use of berberine for PCOS - polycystic ovarian syndromeAn Y, Sun Z, Zhang Y, Liu B, Guan Y, Lu M. The use of berberine for women with polycystic ovary syndrome undergoing IVF treatment. Clin Endocrinol (Oxf). 2014 Mar;80(3):425-31

Wei W, Zhao H, Wang A, Sui M, Liang K, Deng H, Ma Y, Zhang Y, Zhang H, Guan Y. A clinical study on the short-term effect of berberine in comparison to metformin on the metabolic characteristics of women with polycystic ovary syndrome. Eur J Endocrinol. 2012 Jan;166(1):99-105.

Wu X, Yao J, et al. Berberine improves insulin resistance in granulosa cells in similar way to metformin. Fertility and sterility.2006; supplement S459-S460.

Yang J et al. Berberine improves insulin sensitivity by inhibiting fat store and adjusting adipokines profile in human preadipocytes and metabolic syndrome patients. Evid Based Complement Alternat Med. 2012

Zhao L et al. Berberine improves glucogenesis and lipid metabolism in nonalcoholic fatty liver disease. BMC Endocr Disord. 2017 Feb 28;17(1):13.

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.