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WTF is MTHFR?

The world of genetics is confusing AF.  But trust me, you will be hearing more and more about genetics in the coming years.  In 2003 researchers completed The Human Genome Project, a many year endeavour to sequence the human genome and understand what our genes can tell us about our health.  And one of the most important genes identified was MTHFR.

MTHFR

MTHFR is the acronym for the gene that makes methylenetetrahydrofolate reductase. This is an essential step in the methylation pathway – a complex pathway that results in the production of neurotransmitters (mental health), glutathione (liver, inflammation and antioxidant health), and processing of estrogen and testosterone (hormone health). Methylation has been considered by many to be the most important enzyme function in the human body.

MTHFR Polymorphisms

Somewhere between 30-50% (perhaps more) people carry a mutation (also called a single nucleotide polymorphism – or SNP) in the MTHFR gene, with an estimated 14-20% of people having a more severe mutation. First identified by the Human Genome Project, researchers noted that people with the MTHFR mutation were more likely to develop certain diseases, including ADHD, autism, Alzheimer’s, atherosclerosis and autoimmune disorders.

Autism Alzheimer’s ADHD Atherosclerosis Miscarriages Fibromyalgia
Deep vein thrombosis Neural tube defects Gluten intolerance Pernicious anemia Schizophrenia Chronic fatigue syndrome
Post-menopausal depression Chemical sensitivities Parkinson’s Irritable bowel syndrome Pre-eclampsia Stroke
Spina bifida Bipolar disorder Male infertility Vascular dementia Blood clots Congenital heart defects
Gastric cancer Migraines with aura Low HDL cholesterol Epilepsy Atherosclerosis Oral clefts
Type I Diabetes Cervical dysplasia Glaucoma Prostate cancer Multiple sclerosis Essential hypertension
Thyroid cancer Premature death Heart murmurs Placental abruption Myocardial infarction Tongue tie
Asthma Bladder cancer Low testosterone Heavy metal toxicity
Conditions Associated with MTHFR Polymorphisms

It is important to remember that just because you have inherited a gene (thanks mom and dad), does not mean you will develop one of these health conditions. There are many factors (diet, lifestyle, nutritional status, environment) that contribute to gene expression.

Your genes are not your destiny, but they are your tendency

MTHFR C667T and MTHFR A1298C

Two main MTHFR mutations have been identified and are the focus of most research.

Mutations are inherited from our parents, and as such we have two copies of each gene. A mutation on either of these genes can be heterozygous (+/-) – meaning only one copy is abnormal – or homozygous (+/+), meaning both inherited copies is mutated. Homozygous mutations are more likely to cause health problems. And having a homozygous mutation in both MTHFR C667T and MTHFR A1298C is considered to be the most problematic.

The Consequences of MTHFR Mutations

The importance of the methylation cycle, impacted by MTHFR mutations, can not be understated. Some of the consequences of altered MTHFR function include:

  • Decreased methylationMTHFR, naturopath, nutrigenomics
  • Increased heavy metal toxicity (iron, copper, lead, mercury)
  • Low iron (often secondary to elevated copper)
  • Increased homocysteine leading to vascular inflammation (cardiovascular disease, increased blood pressure, increased risk of vascular dementia)
  • Poor conversion of homocysteine to glutathione (increased stress, fatigue, toxin build up, cellular stress)
  • Poor conversion of homocysteine to methionine (increased atherosclerosis, non-alcoholic fatty liver disease, anemia, inflammation)
  • Decreased production of SAMe and decreased serotonin levels (depression)

Nutrigenomics for MTHFR

One of the main reasons I became interested in genetic medicine, is the ability of nutrients, diet and lifestyle to strongly influence the function of our genes.  This field of study is known as nutrigenomics. 

When we know what our genetic tendencies are, we can alter and optimize them through dietary and supplemental choices. It’s an empowering way to look at our bodies.

In order to optimize MTHFR function, there are some things that need to be avoided:

  1. Synthetic folic acid – further slows the MTHFR function
  2. Cyanocobalamin – a form of vitamin B12 that slows methylation
  3. Birth control pills – block the uptake of folate in the gut
  4. Methotrexate – another medication that blocks folate uptake
  5. Proton pump inhibitors – a medication for heartburn that alters stomach acid levels and decreases vitamin B12 absorption
  6. Processed grains – contain synthetic folic acid
  7. Mercury amalgams and heavy metals – can lead to greater heavy metal toxicity due to poor metal clearance

Individuals who have MTHFR polymorphisms will often thrive with appropriate nutritional support. Supplements that can help to improve methylation are the cornerstone of MTHFR therapy.

Supplemental Support for MTHFR

Folate – natural folate, from leafy green plants (foliage – that’s how folate got its name!) and natural supplements will help to improve methylation. Especially important during the months prior to pregnancy, women of reproductive age with MTHFR mutations should be taking folate regularly.

Vitamin B6 – an essential cofactor in the methylation pathway, vitamin B6 helps to ensure folate works properly.

Vitamin B12 – vitamin B12 is a methyl donor – it contributes a methyl group to the methylation pathway, allowing it to function at optimal capacity. B12 should be taken in the methylcobalamin or hydroxycobalamin form, and never in the cyanocobalamin form.

Treatments for MTHFRTMG (Trimethylglycine or Betaine) – another methyl donor, providing three methyl groups to the methylation cycle, this nutrient is commonly deficient in people with MTHFR. Stress, infections, inflammation and high levels of heavy metals will all increase the demand for THM. In a healthy body, plenty is made, but it is also available as a supplement and in foods such as broccoli, beets and other vegetables. TMG is especially useful for people with depressive symptoms as it increases the production of SAMe.

SAMe – a consequence of poor MTHFR function is low levels of SAMe. Essential for the production of serotonin, low SAMe can be associated strongly with depression. SAMe acts as a methyl donor in the body, and is made in the body through methylation processes. Supplementation is available although often levels improve with supplementation of methyl donors, B12 and folate.

NAC (N-Acetyl Cysteine) – a direct precursor to the production of glutathione. NAC can be used to support detoxification and decrease oxidative damage in people with MTHFR mutations.

Confused? 

You’re not alone!  The study of genetics, and the influence of our genes on our health, is some pretty deep, dark science stuff!  But it’s also incredibly informative, and empowering.  And if you’ve ever wondered how your genes are impacting your health, you should consider genetic testing and working with a Naturopathic Doctor,  Geneticist or Functional Medicine Doctor who can help you understand your genetic tendencies, and realize your optimal health potential.

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.

 

Problems with Pill: Nutrient Depletion

Oh the pill.  Many of the women in my practice have a love-hate relationship with this medication.  Some of the things I commonly hear:

  • My skin looks better on the pill
  • I’ve been on the pill since I was a teenager and am scared to go off
  • The pill is treating my PCOS
  • I don’t want to be taking synthetic hormones but I don’t know what else to do
  • The pill makes me crazy every month
  • I’ve never really thought about the pill…

The most common thing I see is that women take the pill without ever really questioning it.  No doubt it is an incredible medicine, that had a huge impact on women and feminism.  But it is not the cure-all for women’s troubles that we are told it is.

In the article Problems with the Pill, I share some of the concerns that I, as a naturopathic doctor and women’s health expert, have regarding the pill. The purpose is not to convince you to give up the pill, but to empower you with information.  This article starts the conversation by looking at the nutrient deficiencies resulting from the pill.

Nutrient Deficiencies and the Pill 

Folic acid (folate)

Foliage (leafy greens), are the best source of folate

Since the ‘60s it has been consistently found that women taking the pill have lower levels of folate in their blood streams. Due to changes in folate metabolism and absorption, folate levels drop in women on the pill, and are lowest in women with longer use. Folate is necessary for DNA synthesis and cell division, and is essential for healthy development of a fetus (low levels can lead to neural tube defects and cleft palate.)

Vitamin B2 (riboflavin)

Riboflavin is an essential B vitamin, necessary for the production of energy, and the metabolism of fats and carbohydrates. Vitamin B2 is not stored in the body, so deficiency is common, and is worsened by the use of the pill.

(An interesting aside, supplementing vitamin B2 can be incredibly effective in managing headaches and migraines, a common side effect of the birth control pill.)

Vitamin B6 (pyridoxine)

A superstar B vitamin, vitamin B6 is needed for protein, fat and carbohydrate metabolism (turning food into muscles and energy – yes please!), it is also necessary for the production of our feel good neurotransmitter, serotonin. The drop in vitamin B6 levels in women on the pill is especially troubling because low B6 is associated with an increased risk of blood clots (a common side effect of the pill.)

Vitamin B12 (cobalamin)

Eggs are a source of vitamin B12

The last of the B vitamins depleted by the pill, vitamin B12 is essential for the production of energy in our mitochondria, for burning fat and carbohydrates as energy, and for healthy red blood cell production. B12 deficiency is even more of an issue in vegans and vegetarians, as the only food sources are from animals, or supplements.

Vitamin C

One of the most important antioxidants in our bodies, vitamin C is also essential for immune function, and preventing heavy metal toxicity. The estrogen found in the pill changes the rate of metabolism of vitamin C, leading to increased loss in the urine. A low intake of vitamin C (not getting your 8-10 servings of fruit and vegetables daily!) can make this problem much more serious. Taking a vitamin C while using an oral contraceptive may also reduce some of the cardiovascular risks associated with the pill.

Vitamin E

Not just one single vitamin, but a group of vitamins (the tocopherols), vitamin E is an antioxidant, with the special ability to be recycled and reused multiple times. It is also a fat-soluble antioxidant, meaning it can get into our cell membranes and protect them from damage. Low vitamin E levels can promote platelet clotting, increasing the risk of blood clots – again, a major concern for women on the pill.

Magnesium

Over 300 different enzyme systems use magnesium, including all the enzymes for energy production. Many of my patients also recognize the possible side effects of low magnesium levels – headaches, muscle cramps, restless legs, migraines, anxiety, and constipation. The pill can seriously reduce magnesium levels in the body, leading to imbalances in calcium and magnesium ratios, increasing the risk of blood clots (again!)

Selenium

Seeds are excellent sources of selenium

One of the most important nutrients for the thyroid, and for every cell that uses thyroid hormone (listen up ladies, 1 in 6 of you also has a thyroid dysfunction.) Deficiencies of selenium have been implicated in Hashimoto’s thyroiditis, as well as heart disease and cancer. The pill reduces the ability of the body to absorb selenium, and combined with the low selenium content of food grown in Ontario soils, this can be a serious issue in women’s health.

Zinc

The last of our nutrient depletions associated with the pill (I think that’s enough already!), zinc is incredibly important to our brain function (“no zinc, no think”), learning and memory. It is also involved in immune function, DNA metabolism and apoptosis (programmed cell death that, when it goes awry, can lead to cancer.)   We don’t know if the zinc depletion seen in women using the pill is due to changes in absorption, excretion, or increased demand, but since the 1960s we’ve known women taking the pill have lower zinc levels.

Next Steps…

A high quality multivitamin and mineral supplement may be enough to provide you with the nutrients you need while taking the pill.  However, all supplements are not created equal.  Speak to your Naturopathic Doctor about the appropriate form of nutrients and dosage for you.  And if you’re interested in working with me, book a meet-and-greet or initial consultation to get started on achieving your vibrant, amazing health.

Selected References

Palmery M, Saraceno A, Vaiarelli A, Carlomagno G. Oral contraceptives and changes in nutritional requirements. European Review for Medical and Pharmacological Sciences. 2013;17:1804-1813.

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.

Natural Treatments for Tinnitus

Tinnitus impacts nearly 400 000 Canadians and can severely impact the quality of life. Tinnitus is defined as the perception of sound without an external source. It may be described as a hissing, ringing, or whooshing noise.   Many individuals diagnosed with tinnitus are told that the condition is chronic, will never improve, and they will just have to learn to live with it.

While Naturopathic Medicine can not guarantee a successful treatment of tinnitus, there may be hope in some of the integrative treatments available.

Cause of Tinnitus

The exact underlying cause of tinnitus is not known. It can be associated with noise trauma (explosions, loud noises), physical trauma, post-inflammation, anxiety and other conditions. In many cases an underlying cause is not identified.

The symptoms of tinnitus may be processed by different parts of the brain than typical auditory pathways. The amygdala and limbic system – parts of the brain responsible for memory and emotions – seem to play a significant role in tinnitus.

Diagnosis of Tinnitus

Diagnosis of tinnitus is generally clinical – the presence of a reported noise with no external source. An audiologist assessment should also be performed. A contrast MRI is also a useful tool and can identify possible underlying causes of tinnitus. Blood work for autoimmune antibodies, vitamin B12, inflammatory markers (ESR), cholesterol levels, blood sugar levels, thyroid-stimulating hormone and comprehensive hormone testing can also provide useful information in identifying metabolic, hormonal, or autoimmune cases of tinnitus. Questionnaires can also be valuable in tracking progress with integrative treatment options.

Conventional Treatment Options

There are several different treatment options offered by qualified audiologists. Many involve sound therapy, masking, hearing aids or tinnitus retraining devices. A referral to an experienced audiologist is necessary for these treatments.

Correcting underlying causes of tinnitus will be helpful in a patient-by-patient basis. If the tinnitus is caused by a hormonal imbalance, such as thyroid disease, correcting the thyroid dysfunction can lead to resolution of symptoms. Antidepressants (impacting serotonin and/or dopamine) and GABA-enhancing medications have also been used in some individuals with success.

Naturopathic Treatment Options

While no guarantee of success exists in the treatment of tinnitus, the lack of conventional treatment options leads many people to seek out natural and integrative therapies. The majority of these options are safe and may provide some degree of relief to people suffering with tinnitus. Working with a knowledgeable Naturopathic Doctor is advised as these treatments may have side effects or interactions with other medications.

Ginkgo biloba

One of the most commonly sold botanical medicines worldwide, ginkgo is used to increase blood flow to the head and treat symptoms of Alzheimer’s disease, dementia and vascular tinnitus. ginkgo has antioxidant, neuroprotective and platelet-inhibiting effects. Studies suggest that ginkgo may have a positive impact on patients with tinnitus, by increasing blood flow to the ear and may be especially useful in the elderly. The use of ginkgo may be limited by its interactions with medications, especially blood thinners, aspirin and seizure medications.

Zinc

Zinc is an essential mineral with significant actions in the central nervous system, including the hearing pathway, as well as in hormone production, enzyme function, and synthesis of DNA and RNA. Studies have suggested that zinc deficiency impacts between 2-69% of individuals with tinnitus. Giving zinc to individuals with tinnitus is a low risk intervention, and measuring serum zinc levels may identify those in greatest need for supplementation.

Melatonin

Melatonin, a hormone produced by the pineal gland during the night, regulates sleep/ wake cycles and acts as an antioxidant. Some studies have found that supplementing melatonin may improve tinnitus, especially in individuals with sleep disturbances. Melatonin may also help in individuals with stress by balancing cortisol production, another hormone often involved in tinnitus.

Vitamin B12

An important nutrient, and common deficiency, there have been studies showing a relationship between vitamin B12 deficiency and abnormal function of the hearing pathway. For every individual experiencing tinnitus, vitamin B12 levels should be assessed and optimal levels should be achieved through dietary and supplemental means.

Garlic

The flavourful garlic bulb is useful for many cardiovascular conditions. It has cholesterol-lowering effects, lowers blood pressure and can decrease blood clot formation. It may be useful for tinnitus by improving blood flow to the inner ear. There are no current studies on the use of garlic for tinnitus, but the possible benefits are evident.

Pycnogenol

Preliminary research suggests that the antioxidant, pycnogenol (pine bark extract) can decrease symptoms of tinnitus after one month of use. It is suspected that it’s influence on inflammation and the cardiovascular system may lead to improvements in tinnitus.

Hormone Modulation

Hormonal imbalances have been identified in many individuals experiencing tinnitus, with imbalance in the hypothalamus-pituitary-adrenal (HPA) axis being most common. This HPA axis is involved in the stress response, with abnormal cortisol production being a common feature. One study found that individuals with tinnitus had a blunted cortisol response after stressful events. Identifying and correcting underlying hormonal imbalance can improve tinnitus in some people, especially those with stress.

Acupuncture

Several studies have demonstrated improvement in tinnitus symptoms with acupuncture treatment. Improvements with acupuncture have not been found in all studies, and improvements may be short lived (average of 100 hours in one study). Acupuncture is a very safe treatment, with limited side effects and no interactions with medications. Administered by a qualified naturopathic doctor or acupuncturist, it may be a valuable option for the treatment of tinnitus.

Taking an integrative approach, managing stress and balancing your hormones may help to improve the symptoms of tinnitus, and also improve the quality of life of people suffering with tinnitus. To learn more, speak to a qualified Naturopathic Doctor.

References:

The sound of stress: blunted cortisol reactivity to psychosocial stress in tinnitus sufferers. Hébert S, Lupien SJ. Neurosci. Lett. – January 10, 2007; 411 (2); 138-42

Diagnostic value and clinical significance of stress hormones in patients with tinnitus. Kim DK, Chung DY, Bae SC, Park KH, Yeo SW, Park SN. Eur Arch Otorhinolaryngol – November 1, 2014; 271 (11); 2915-21

Hormones and the auditory system: A review of physiology and pathophysiology Neuroscience, 2008-06-02, Volume 153, Issue 4, Pages 881-900, Copyright © 2008

Complementary and Integrative Treatments for tinnitus Gregory S. Smith MD, Massi Romanelli-Gobbi BM, Elizabeth Gray-Karagrigoriou Au.D and Gregory J. Artz MD  Otolaryngologic Clinics of North America, The, 2013-06-01, Volume 46, Issue 3, Pages 389-408

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.

 

10 Tips to Treat PMS Naturally

PMS (premenstrual syndrome) sucks.  That’s not medical jargon, that’s just the way it is.  Once a month, up to three-quarters of women experience physical or emotional discomfort or pain which can last up to 14 days (two weeks!!).  Over 150 symptoms of PMS have been identified but the most common symptoms are:

Naturopathic treatment of PMS
There are over 150 symptoms associated with PMS
  • Decreased energy
  • Irritability, nervousness, anxiety and anger
  • Food cravings
  • Depression
  • Headache
  • Altered sex drive
  • Breast pain
  • Muscle aches and low back pain
  • Bloating
  • Diarrhea and/ or constipation
  • Swelling of the hands and feet
  • Trouble concentrating
  • Difficulty sleeping

What causes PMS?

Honestly, we don’t exactly know what causes PMS.   It’s most likely a combination of imbalances in our hormones, neurotransmitters and environment that leads to symptoms of PMS.

Balancing these diverse systems gives most women relief from their PMS symptoms.  It sometimes takes time to determine which treatment is right for you.  An experienced Naturopathic Doctor will be able to tailor an individualized plan to give you the best chance for success.

10 Tips to Treat PMS Naturally

1. Exercise

Exercise is important for your overall health, but it can also decrease symptoms of PMS.  Studies have shown again and again that women who engage in regular exercise have fewer PMS symptoms than women who do not.  And the exercise doesn’t need to be intense – it just needs to happen regularly (at least 3 times per week throughout the month).

Exercise is thought to reduce PMS symptoms by reducing estrogen levels, improving glucose tolerance and raising endorphin levels.  Aerobic exercise (swimming, cycling, running, etc), yoga or tai chi are all beneficial.

2.    Cut out sugar

Women who experience PMS have been reported to eat whopping 275% more refined sugar than women who do not get PMS symptoms.  Refined sugars deplete our magnesium levels, increase sodium and water retention and create imbalances in our insulin levels.  All of these processes have been linked to the development of PMS symptoms.

Eliminating refined sugar and limiting simple carbohydrates in favour of high fiber complex carbohydrates lowers blood levels of estrogen, improves magnesium levels and can significantly improve symptoms of PMS.   So cut out the cookies, cakes, bagels and breads in favour of oatmeal, popcorn, quinoa, brown rice and other fiber rich foods.

 3.    Eliminate caffeine

Caffeine consumption is associated with more and worse PMS symptoms.  Caffeine is linked especially to breast tenderness,anxiety, irritability and difficulty sleeping during PMS.  The impact is even worse when combined with sugar (pay attention all you Frappuccino drinkers!).  Eliminating caffeine, or limiting it during the premenstrual phase can improve PMS symptoms for a lot of women.

4.    Take a probiotic

Probiotics are not just for digestive health!  Having good bacteria in our intestines has wide ranging benefits for our health.  Healthy bacteria can decrease symptoms of PMS by increasing beta-glucuronidase enzyme activity and promoting estrogen excretion.

The best way to establish a healthy bacteria flora in your intestinal tract is to take a probiotic supplement.  Try for one with both Lactobacillus acidophilus and Bifidobacterium bifidum.  Taken with food, probiotics are extremely safe and have no negative side effects (you can experience bloating if you take too much – 1 to 10 billion is usually a safe amount).

 5.    Take a calcium and magnesium supplement

1k-7649 spinachThere is a direct relationship between calcium and estrogen.  Estrogen is involved in the absorption, metabolism and utilization of calcium in our bodies.  Clinical trials have found that both mood and physical symptoms of PMS are improved with daily calcium supplementation

Magnesium deficiency is a major concern and is seen in a majority of women with PMS.  Magnesium deficiency causes fatigue, irritability, mental confusion, menstrual cramps, insomnia, muscle aches and pains and heart beat irregularities.

Dietary sources of calcium include dark green leafy vegetables, dairy (cheese, yogurt, milk), tofu, and almonds.  Dietary sources of magnesium are similar and include green leafy vegetables, tofu, legumes, nuts, seeds and whole grains.  Calcium and magnesium supplements should be taken in the evening, away from iron supplements and thyroid medications.

6.    Take B vitamins

B vitamins are involved in hundreds of different processes in our bodies.  The liver uses various B vitamins to detoxify estrogen and allow our bodies to eliminate it.

Additionally, pyridoxine (vitamin B6) can ease symptoms of PMS by increasing production of the neurotransmitters serotonin and dopamine.  Low levels of these neurotransmitters have been suggested as a cause of many PMS symptoms including low energy, irritability and mood swings.

As if that wasn’t enough, B6 is also involved in transfer of magnesium into cells – without B6 magnesium wouldn’t be able to enter cells.  This is another reason why B vitamins, and especially B6 are so important in the relief of PMS symptoms.

7.    Dong Quai

Dong Quai (Angelica sinensis) is a traditional Chinese herb with thousands of years of use for imbalances in the female reproductive system.  It has been used for menopause, painful menstruation, no menstruation and as a uterine tonic.  Dong quai has phytoestrogenic properties and is best used for women who experience PMS symptoms in addition to painful menstruation.

 Dong quai is usually used from ovulation (day 14) until menstruation begins.  If you are also experiencing painful periods, continue it until your period stops.

 8.    Chaste tree

While best known as a treatment for menopause, chaste tree (Vitex agnus castus) is probably the single most important herb in the treatment of PMS.

The effects of chaste tree appear to be due to the impact it has on the hypothalamus and pituitary – the starting point for hormone production in the body.  As a result, chaste tree is able to normalize the secretion of many hormones, for instance, reducing prolactin levels and normalizing the estrogen to progesterone ratio.

Chaste tree is best taken daily throughout the menstrual cycle.  Studies have found it to be useful for almost all symptoms associated with PMS including irritability, mood swings, anger, anxiety, headache, and breast tenderness.

9.    Licorice

Licorice (Glycyrrhiza glabra) is an amazing herb!  It has been used in both Western and Eastern herbal medicine for thousands of years for a wide variety of ailments.  It also has impressive modern scientific research to back up its historical uses.

 Licorice is useful in the treatment of premenstrual syndrome because it lowers estrogen levels while simultaneously raising progesterone levels.  Licorice also blocks the hormone aldosterone, decreasing water retention.

 Licorice is usually taken from ovulation (day 14) until your period starts.  It should not be used if you have a history of kidney disease or high blood pressure.  You should be under the care of a Naturopathic Doctor while taking licorice.

10. See a Naturopathic Doctor

This is probably the best thing you can do to help manage your PMS symptoms.  Naturopathic Doctors are experts in correcting the underlying imbalances that lead to PMS symptoms.  Your unique set of symptoms will give an experienced ND a lot of information that can be used to individualize a treatment plan just for you.  NDs also can order comprehensive hormone panels that will identify imbalances in prolactin, estrogen, progesterone or testosterone that may be contributing to your symptoms.  You can find a licensed Naturopathic Doctor in your area by visiting the national association websites – CAND in Canada and AANP in the United States.

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.

Photo credits:

Creative Commons License Mislav Marohnić via Compfight

Creative Commons License Ed Yourdon via Compfight

Tim Hamilton via Compfight

Natural Approaches to Heartburn

The number of patients in my practice with heartburn is staggering. And what is even more staggering to me is how many people think it is normal! Just because it is common does not mean that it is normal!

What is Heartburn?

Heartburn, also known as reflux or gastroesophageal reflux disease (GERD) is a burning sensation in the esophagus that may be associated with:

  • Sour, acidic taste in the mouth
  • Pain behind the breastbone or between the shoulder blades
  • Unexplained cough

A New Perspective on Heartburn

In conventional medicine, heartburn is the consequence of excess stomach acid and acid suppressing medications (proton pump inhibitors or calcium carbonate) to reduce symptoms. However, functional doctors and naturopathic doctors believe that low stomach acid may be a more likely cause of heartburn.

Stomach acid is necessary to for proper digestion. If acid production is decreased the stomach will not empty properly and the contents (partially digested food and stomach acid) can reflux up into the esophagus and cause heartburn.

Stomach acid production naturally declines as we age. Stress, unhealthy diet (high in refined grains, sugars and processed foods) and use of medications are all common causes of low stomach acid.

Treating Low Stomach Acid

Water There are a number of natural ways to improve your production of stomach acid. Your Naturopathic Doctor can help you to understand which options are best for you.

  1. Become a “chewitarian” – the longer the food spends in your mouth, the more signals your brain and enyzmes in your saliva will send to your stomach to produce stomach acid. So slow down, chew carefully and savour each bite.
  2. Limit beverages at mealtimes – water and other fluids can dilute stomach acid, requiring our body to produce more. Take only small sips of water during meals and save the majority of your water for between meals.
  3. Apple cider vinegar – can help low stomach acid by providing a source of acid, allowing your stomach to have an optimal pH even if you aren’t making enough stomach acid on your own. Doses vary, start low with 1 tsp and see if it helps you.
  4. Betaine hydrochloric acid – a powerful treatment for heartburn and low stomach acid, betaine HCl provides you with a safe source of stomach acid. This will help optimize your stomach acid levels and promote total digestion of food, leading to a healthy stomach emptying time and decreased symptoms. Your ND will give you guidelines on safe supplementation.
  5. Deglycyrrhizinated licorice (DGL) – an excellent support for heartburn, DGL improves symptoms of heartburn by healing the esophagus and tonifying the lower esophageal sphincter – the opening at the top of the stomach. Try chewing one capsule when you experience heartburn to decrease symptoms while you work to optimize your stomach acid levels.

The Importance of Treating Heartburn

Heartburn may be miserable, and uncomfortable and for many that is reason enough to try to clear the symptoms. But getting to the underlying cause of the heartburn is important because optimal digestion of our food is the only way we will get all of the nutrients we need for our bodies to function.

If you are producing inadequate stomach acid, or taking acid-suppressing medications, you may experience difficulty breaking down protein, an increase in food sensitivities, deficiencies in nutrients, and increased inflammation. The consequences of poor nutrient absorption can not be underestimated!

So speak with your Naturopath today to find ways to optimize your health and overcome your heartburn symptoms, once and for all!

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.

 

Naturopathic Medicine and Endometriosis

Endometriosis is a chronic condition affecting millions of Canadian women. It can begin at any age between the teens and 40s and impacts between 10-15% of women in these age groups.

There is no cure for endometriosis, but Naturopathic Medicine can offer women with this condition hope for improved hormone balance, decreased pain and support for fertility.

Prior to reading this article, I suggest you check out Understanding Endometriosis to learn how to recognize the symptoms of endometriosis and the underlying imbalances that lead to this frustrating condition.

Naturopathic Treatments for Endometriosis

A Naturopathic treatment plan for endometriosis will be highly individualized to each person, addressing their unique lifestyle, dietary and symptom needs. The treatment goals vary person to person, but always include a combination of the following:

  • Normalize the function of the immune system
  • Balance hormones
  • Support liver detoxification of hormones
  • Reduce and block pro-inflammatory chemicals produced by the body
  • Support the large intestine and microbiome (healthy bacteria)
  • Decrease stress

Vitamin CBy addressing these underlying imbalances in endometriosis Naturopathic Doctors can improve the overall health of women with endometriosis, decrease or eliminate symptoms of endometriosis and address the underlying cause of endometriosis.

Normalize Immune Function

There are many nutrients involved in healthy immune function. One of the largest categories of immune supportive nutrients are the antioxidants. Nutrients like vitamin C, beta carotene, vitamin E and selenium all enhance immune function and can be used to support endometriosis treatment. Many of these nutrients also decrease inflammation and can improve pain associated with endometriosis.

Vitamin D, an incredibly important nutrient for Canadians, has profound impacts on endometriosis. Vitamin D regulates cell growth and differentiation in endometriosis, enhances macrophage action and decreases inflammation. Vitamin D supplementation has been found in studies to reduce the weight of endometriosis lesions as well.

Balance Hormones

hormone balanceEndometriosis is a hormonally responsive condition – the growth of the endometrial lesions occurs under the influence of estrogen – so balancing hormone levels is an important treatment goal for all women with endometriosis.

Phytoestrogens, such as lentils, flax seeds and soy, can bind to estrogen receptors and have a less potent effect than our body’s own estrogen. When these phytoestrogens are bound to receptors they displace our own estrogen resulting in a lower estrogen effect overall. These foods should be incorporated into our diet daily for optimal hormone balancing effects.

Indole-3-carbinole and DIM (di-indolylmethane) from brassica vegetables are also estrogen regulating supplements that act much like phytoestrogens by binding estrogen receptors and decreasing our body’s estrogen response. Your Naturopathic Doctor may recommend these supplements, or recommend increasing consumption of broccoli, cauliflower, cabbage and brussels sprouts for hormone balancing in endometriosis.

Reduce Inflammation

Grapes are a source of resveratrolMany of the most profoundly effective treatments for endometriosis work by reducing inflammation in the body. Pycnogenol, a pine bark extract, has anti-inflammatory, immune supportive and anti-growth properties. Studies have shown significant improvements in pain symptoms in women using pycnogenol.

Resveratrol, a substance found in the skin of grapes, is especially beneficial for women with endometriosis and infertility. Resveratrol can decrease inflammation, reduce proliferation of endometrial lesions and protect eggs from the effects of aging.

N-acetyl cysteine (NAC) is one of the most promising treatments for endometriosis. Studies have found immune function improvements (increases in T regulatory cells, decreases in TNF-alpha), significant decreases in inflammation (including increases in glutathione – a cellular anti-inflammatory) as well as reduces in the size of existing endometrial lesions.

Support Liver Detoxification

The liver is essential for hormone balance as it is where our body detoxifies estrogen and prepares it for elimination. B vitamins are necessary for this function, allowing the liver to more efficiently inactivate and process estrogen.

Nutrients known as lipotropics also promote liver function by promoting the flow of fat and bile (containing estrogen for elimination) out of the body through the large intestines. Choline, betaine, methionine and dandelion are all prime examples of lipotropics that can be used to enhance liver detoxification in endometriosis.

oatmealSupport Large Intestines and Healthy Bacteria

Our body eliminates estrogen by attaching it to a carrier molecule (glucuronic acid) and excreting it through the bile into the stool. Unfriendly bacteria in the large intestines can prevent our ability to eliminate estrogen by breaking this bond between estrogen and it’s carrier. This estrogen is then recycled back into our body, resulting in higher circulating levels of estrogen.

We can modify this action, and support healthy hormone levels, by following the Endometriosis Diet which emphasizes healthy fiber and avoidance of unhealthy fats. Probiotic supplements can also be used in some cases to encourage healthy bacteria balance.

Decrease Stress

Stress occurs frequently in our fast-paced society, but we know that unhealthy levels of stress, or poor adaptation to stress is linked to decreased immune function and may trigger the kind of biochemical imbalances that lead to endometriosis. Studies have demonstrated that endometriosis grows more rapidly, or recurs faster and in greater quantities, during times of extreme emotional stress.

Breathing exercises, physical exercise, yoga, meditation, mindfulness, good quality sleep and adaptogenic herbs and supplements can decrease your stress response and help you to manage your endometriosis, naturally.

Not All Nutrients Are Beneficial

Just because it’s natural, does not mean it’s safe. It is strongly recommended to consult with a Naturopathic Doctor to develop a safe and effective endometriosis plan that will address your concerns and give you the best chances for success.

Additionally, some nutrients may negatively impact endometriosis. L-carnitine, an amino acid, was shown in one study to induce a condition resembling endometriosis with accompanying infertility when give to young female mice. We are not sure of the impact this may have on humans, but a cautious approach is recommended.

Treating Endometriosis

Understanding EndometriosisTo take a fully empowered, knowledgeable approach to your endometriosis I recommend you read the other articles written by Dr. Lisa Watson, ND on endometriosis: Understanding Endometriosis, The Endometriosis Diet, Endometriosis and the Immune System, Acupuncture and Endometriosis and Endometriosis and Infertility.  If you are ready to take the next step, book a complimentary 15 minute meet-and-greet appointment with Dr. Watson, or book an initial consultation.  You can feel better! Get started now.

References

Hudson, Tori. Women’s Encyclopedia of Natural Medicine. New York: McGraw Hill, 2008.

Lauersen, Niels H and Bouchez, Collette. Getting Pregnant. New York: Fireside, 2000.

Lewis, Randine. The Infertility Cure. New York: Little, Brown and Company, 2004.

Kohama T, et al. Effect of French maritime pine bark extract on endometriosis as compared with leuprorelin acetate. Journal of Reproductive Medicine; 2007:52(8),703-8

Vassiliadis S, Athanassakis I. A “conditionally essential” nutrient, L-carnitine, as a primary suspect in endometriosis. Fertil Steril. 2011 Jun 30;95(8):2759-60.

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.

Uterine Fibroids: Five Things You Need To Do

Fibroids are non-cancerous growths that develop in the muscle layer of the uterus. Depending on the method of diagnosis a staggering 5 to 77% of women have been found to have fibroids. Fibroids can be very small or very large (up to the size of a watermelon!!)

Symptoms of fibroids depend on the size and location of the fibroid. Fibroids can cause pain, bloating or heavy periods.

We don’t understand exactly what causes the development of fibroids but risk factors include African descent, a family history of fibroids, being overweight and perimenopause. There is also a strong association of fibroids with high estrogen levels, a condition known as estrogen dominance.

While we don’t know exactly how fibroids form, here are five things you should do right now if you have fibroids.

Five Things You Need to Do if You Have Fibroids

  1. Check Your Vitamin D Levels

If you have dark skin or live in colder climates (like Canada) you may have a vitamin D deficiency. Low levels of vitamin D can contribute to the development of fibroids and can lead to inflammation and altered insulin response.

If you have fibroids, you should see your Naturopathic Doctor or Medical Doctor to have your vitamin D levels assessed. A vitamin D supplement is recommended for all Canadians during the winter months, so knowing your current levels is important for determining your individualized optimal dose.

  1. Love Your Gut

    Fermented foods promote healthy bacteria balance
    Fermented foods promote healthy bacteria balance

An imbalance in the levels of bacteria in your digestive tract could be contributing to fibroid growth. This imbalance, known as “dysbiosis”, can lead to increased production of inflammatory mediators which migrate to the pelvis and stimulate the growth of atypical cells that develop into fibroids.

Having dysbiosis can also lead to high levels of estrogen by promoting recirculation of estrogen rather than allowing the body to eliminate it.

Digestive dysbiosis can be caused by antacid use, antibiotics, stress, poor digestion, frequent illness and use of birth control pills.

Dysbiosis can be treated by your Naturopath with the use of probiotics, fermented foods, gut healing nutrients and botanicals.

  1. Be Kind to Your Liver

Balancing hormones requires a healthy liver. The two-phase detoxification process in our livers that allows us to detoxify and eliminate estrogen can be influenced by our diet, stress, herbs and medications.

Make healthy choices every day to love your liver and support estrogen detoxification. Limit or eliminate alcohol, eat less gluten, drink green tea, and eat lots of leafy green vegetables. Your Naturopath may also recommend specific herbs to support the liver or a B complex vitamin supplement.

  1. Balance Your Hormones with FoodCruciferous vegetables for hormone balance

One of the most important things you can do if you have fibroids is to follow a hormone-balancing diet – one that decreases inflammation, balances blood sugar and prevents estrogen dominance.

Foods that can increase inflammation, raise insulin and blood sugar levels, and promote estrogen dominance should be limited or eliminated. These include:

  • Red meat
  • Poultry
  • Dairy products
  • Gluten containing grains
  • Alcohol
  • Sugar and artificial sweeteners
  • Trans fats

Luckily there are also foods that can promote hormone balance and decrease inflammation. These include:

  • Cold water fish
  • Nuts and seeds (especially flaxseed)
  • Cruciferous vegetables – broccoli, Brussels sprouts, cabbage, kale, kohlrabi and cauliflower
  • Beans, peas, lentils, soybeans
  • Water
  1. See a Naturopathic Doctor

If you have fibroids you should consider seeing a Naturopath to get an individualized hormone balance plan. Your ND can identify possible causes of inflammation and imbalance in your life and work with you to find solutions to restore your body to a state of healthy balance. Your Naturopath can also prescribe nutritional supplements and botanical medicines to address your fibroids and overall state of health. You can find a licensed ND in your area by contacting the Canadian Association of Naturopathic Doctors or the American Association of Naturopathic Physicians.

 

A Male Prenatal?

We all recognize the importance of prenatal supplements for women.  But can men benefit too?  Women are encouraged to take a nutritional supplement for at least three months before getting pregnant and I think men should do the same!

Nutrients for Male Fertility

Certain nutrients are needed for the production and protection of sperm.  Making sure that men have enough of these key nutrients can improve sperm count, sperm motility and the percentage of healthy sperm.

Vitamin C and E

Antioxidants for male fertilityVitamins C and E are antioxidants – they protect the body from damage done by reactive oxygen species (ROS or ‘free radicals’).  Sperm are especially sensitive to damage by ROS.  This is why semen contains high amounts of vitamin C and other antioxidants, to protect the sperm from ROS damage.

A diet that is deficient in antioxidant rich fruits and vegetables can lead to lower sperm count, poor motility and more abnormally shaped sperm.

However, you can get too much of a good thing.  Excess doses of vitamin C and E can have pro-oxidant effects – leading to oxidative damage rather than preventing it.  Working with a Naturopathic Doctor can help you determine your optimum dose for fertility.

Selenium

Supplements for Male Fertility

Another antioxidant, selenium deficiency is associated with poor male fertility.  Selenium supports sperm production and supplementation can improve sperm motility and sperm count.

As with vitamin C and E, too much selenium can cause adverse effects.  It is best used in combination with other antioxidants at low dose, or as a food-based nutrient.              

Folic acid

Normally associated with female fertility, men can benefit from folic acid supplementation as well.  Folic acid is necessary for DNA synthesis and the protection of DNA during sperm production.

It has been suggested that supplementing men with folic acid may decrease miscarriage rate by decreasing genetic mutations.

Zinc

No single nutrient has a greater impact on male reproduction than zinc.  Zinc is necessary for folic acid absorption and metabolism, testosterone production, formation and maturation of sperm and fertilization.

The scary thing is that 79% of men are not consuming even the recommended daily allowance (RDA) of zinc.  Most men who are considering fatherhood could benefit from a zinc supplement.

But as with so many things, you can have too much of a good thing.  Excess intake of trace minerals like zinc can lead to pro-oxidant effects.

Men and women contribute equally to fertility – you each give your DNA to your baby.  Put your best DNA forward and consider seeing a Naturopathic Doctor who can recommend a male prenatal supplement to optimize your fertility, and the health of the next generation.

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.

 

Getting Under Your Skin – Ten Natural Treatments for Psoriasis

Psoriasis is a common condition, affecting more than 50 000 people in Toronto alone.  Both men and women are equally impacted by psoriasis and more than one-third of people with psoriasis have a family member who also has it.

What is Psoriasis?

Psoriasis is a chronic, immune-mediated inflammatory condition that manifests as red, scaly skin rashes (known as “plaques”) that occur on the knees, elbows, scalp and other areas of the body.  The underlying issue that leads to psoriasis is immune activation of T-cells leading to release of inflammatory mediators and hyper-proliferation of keratinocytes.

Naturopathic Treatment of Psoriasis

Naturopathic treatment of psoriasis works to address the underlying causes of psoriasis – immune dysfunction and inflammation.  Correcting the imbalances that lead to psoriasis plaques and arthritis can significantly improve outcomes and promote optimal health.  Listed below are ten natural treatment options for psoriasis.

Ten Natural Treatment Options for Psoriasis

1. Anti-Inflammatory Diet

Food is a major source of inflammatory particles for our body.  Some foods promote inflammation, while other foods inhibit inflammation.  Foods that cause inflammation include: dairy, red meats, partially hydrogenated vegetable oils, safflower oil, canola oil and trans-fats.  These foods should be reduced or eliminated in the diet.

 Foods that reduce inflammation include the omega 3 fatty acids, many spices, and most fruits and vegetables.  A vegetarian diet, or diet rich in fruits and vegetables can decrease inflammation and symptoms of psoriasis.

 2. Identification and Elimination of Food Allergies and Sensitivities

In addition to foods that contain compounds known to lead to inflammation, individual food sensitivities or allergies can also cause inflammation.  Consuming foods that we have a sensitivity to leads to an immune response in our body, ultimately leading to inflammation.  Determining your food sensitivities and eliminating them can profoundly decrease the symptoms of psoriasis.  The most common food sensitivities found in people with psoriasis include gluten (wheat), eggs and dairy.

3. Healthy Weight LossBalance scale

People who are overweight tend to have worse symptoms of psoriasis, likely due to the increase in inflammation from insulin imbalance and the metabolic effects of being overweight.  Achieving and maintaining a healthy body weight is an important lifestyle goal for all people with psoriasis and something your Naturopathic Doctor can help you do in a healthy and long-lasting way.

 4. Manage Stress

Long term stress can deplete our body’s ability to produce cortisol, one of the most powerful natural anti-inflammatories in our body.  Psoriasis tends to worsen during times of stress – whether it is mental, emotional or physical stress.  Learning appropriate stress management skills, and using appropriate natural supplements to decrease the physical impacts of stress can be an effective way of managing psoriasis across your lifespan.

 5. Spice Up Your Life!

Literally! Many spices can be used to decrease inflammation and act as strong antioxidants, promoting healing of skin.  Specific spices that can decrease inflammation and help treat psoriasis include: turmeric, capsaicin (red pepper), cloves, ginger, cumin, anise, fennel, basil, rosemary and garlic.

6. Omega 3 Essential Fatty Acids

Essential Fatty AcidsOne of the most powerful treatments for all forms of inflammation, including psoriasis, is omega 3 fatty acids.  Omega 3s are essential fatty acids, our body can’t produce them and needs to get them from food.  Unfortunately our diets are rich in omega 6s (pro-inflammatory) and deficient in omega 3s (anti-inflammatory).

 Omega 3s have many impacts on the development of psoriasis.  They change the function of cell membranes, modify immune function decreasing overactivation, prevent blood supply from developing in psoriatic plaques and decrease inflammation throughout the body.

 Dietary sources of omega 3 fatty acids include cold water fish (mackerel, salmon, herring, sardines, albacore tuna), flaxseeds, walnuts, algae and hemp seeds.  Supplementing with higher doses of omega 3s is recommended for people with active psoriasis.

7. Vitamin D

People with psoriasis have lower levels of the active form of vitamin D in their blood streams.  At this point it’s not clear if this finding is a cause of psoriasis or a consequence.  It is known that psoriasis is much less common in areas of the world with higher vitamin D production – sunny and warm climates have a much lower incidence than cold climates.  UV phototherapy is another effective treatment for psoriasis that increases vitamin D levels but can have unwanted side effects.

 Supplementing with vitamin D, and using it topically is safe for most people with psoriasis.  A simple blood test is available that will tell you whether this treatment is right for you, talk to your Naturopathic Doctor about it today.

8. Bioactive Whey Protein

Emerging research has shown bioactive whey protein isolate to be a promising treatment for psoriasis.  Whey isolate has immune regulating effects due to the presence of growth factors, immunoglobulin’s and active peptides.  Taking this supplement twice daily showed significiant improvements in psoriasis skin plaques after just two months of use.

9. Curcumin Gel

While much of the healing for psoriasis depends on healing from the inside out, topical use of curcumin gel has been shown to be more effective than calcipotriol cream, one of the most common prescription medications for psoriasis.  After 2-6 weeks of daily use all patients had at least a 50% improvement in psoriasis plaques with half of patients having a 90% improvement.

aloe vera
Aloe vera gel

Curcumin gel works by reducing inflammation locally and in combination with other Naturopathic treatments can be an amazing treatment option for psoriasis.

10. Aloe Vera Gel

Another topical option for healing psoriasis, aloe vera gel is an incredibly gentle and safe treatment with good clinical results.  Not only is aloe vera calming to inflamed skin but it also promotes healthy regrowth of normal skin cells.  One study found an 82% improvement compared to placebo.

Psoriasis is a multi-faceted condition that stems from an imbalance in the immune system leading to inflammation and characteristic skin plaques.  Naturopathic Medicine offers treatment options that address the underlying imbalances and can result in profound improvements in overall health and lead to healthy, clear skin.

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

Calder PC. n-3 Polyunsaturated fatty acids, inflammation, and inflammatory diseases. Am J Clin Nutr 2006;83:1505S-1519S.

Chalmers RJ, Kirby B. Gluten and psoriasis. Br J Dermatol 2000;142:5-7.

Heng MC, Song MK, Harker J, Heng MK. Drug- induced suppression of phosphorylase kinase activity correlates with resolution of psoriasis as assessed by clinical, histological and immunohistochemical parameters. Br J Dermatol 2000;143:937-949.

Perez A, Raab R, Chen TC, et al. Safety and efficacy of oral calcitriol (1,25-dihydroxyvitamin D3) for the treatment of psoriasis. Br J Dermatol 1996;134:1070- 1078.

Pizzorno JE, Murray MT. Textbook of Natural Medicine. 3rd ed. St. Louis, MO: Churchill Livingstone; 2006.

Poulin Y, Bissonnette R, Juneau C, et al. XP-828L in the treatment of mild to moderate psoriasis: randomized, double-blind, placebo-controlled study. J Cutan Med Surg 2006;10:241-248.

Syed TA, Ahmad SA, Holt AH, et al. Management of psoriasis with Aloe vera extract in a hydrophilic cream: a placebo-controlled, double-blind study. Trop Med Int Health 1996;1:505-509.

Traub M, Marshall K. Psoriasis – Pathophysiology, Conventional and Alternative Approaches to Treatment. Alt Med Review. 2007;12(4).

Wolters M. Diet and psoriasis: experimental data and clinical evidence. Br J Dermatol 2005;153:706-714.

Vegetarian 101 – Iron in the Vegetarian Diet

Iron is one of the most important minerals for health.  Iron is used to form hemoglobin which allows our red blood cells to carry oxygen to each and every cell in our body.  Iron deficiency is the most common nutrient deficiency worldwide with up to two billion people affected, mostly women and children, and affects omnivores and vegetarians alike.

Symptoms of Iron Deficiency

Iron deficiency generally develops slowly and symptoms often do not appear until anemia is severe, even though our cells are already suffering the consequences of inadequate iron.

Symptoms of iron deficiency are similar in all age groups and include:

iron in the vegetarian diet

  • Fatigue
  • Dizziness
  • Shortness of breath
  • Irritability
  • Pale skin
  • Sore tongue
  • Dark coloured stools
  • Frequent infections
  • Sensitivity to temperatures (cold or heat)
  • Pica (the desire to eat non-food substances – most commonly ice or dirt)

Vegetarians have no higher incidence of iron deficient anemia than the omnivore population, however there are some additional precautions vegetarians must take to ensure an adequate dietary intake of iron.

Absorption of Iron from the Diet

Green leafy vegetables are a source of vegan ironDietary sources of iron are either heme-based (from animal sources) or non-heme (vegetarian.)  Some foods (such as cereals and infant formulas) are also iron-enriched or iron-fortified – non-heme iron is used in these foods.

Although a vegetarian diet is likely to contain as much (or more) iron than an omnivorous diet, the non-heme iron in a vegetarian diet is substantially less available for absorption because of differences in the chemical form of iron and accompanying constituents that inhibit iron absorption (such as calcium, tannins and phytates).

Vegetarians need to consume approximately 80% more iron than indicated by the national Recommended Daily Intake (RDI) due to the decreased bioavailability.  Absorption of non-heme is estimated to be 10%, although more will be absorbed in cases of severe anemia.  By comparison the absorption of non-heme iron is approximately 18%.

Iron absorption can be enhanced by combining iron rich foods with a source of vitamin C, using iron cookware (especially for cooking acidic foods that solubize iron from the pan), sprouting grains and avoiding coffee, tea and red wine with meals.

Vegetarian Food Sources of Iron

Food Amount Iron (mg)
Soybeans,cooked 1 cup

8.8

Blackstrap molasses 2 Tbsp

7.2

Lentils, cooked 1 cup

6.6

Spinach, cooked 1 cup

6.4

Tofu 4 ounces

6.4

Bagel, enriched 1 medium

6.4

Chickpeas, cooked 1 cup

4.7

Tempeh 1 cup

4.5

Lima beans, cooked 1 cup

4.5

Black-eyed peas, cooked 1 cup

4.3

Swiss chard, cooked 1 cup

4.0

Kidney beans, cooked 1 cup

3.9

Black beans, cooked 1 cup

3.6

Pinto beans, cooked 1 cup

3.6

Turnip greens, cooked 1 cup

3.2

Potato 1 large

3.2

Prune juice 8 ounces

3.0

Quinoa, cooked 1 cup

2.8

Beet greens, cooked 1 cup

2.7

Tahini 2 Tbsp

2.7

Veggie hot dog, iron-fortified 1 hot dog

2.7

Peas, cooked 1 cup

2.5

Cashews 1/4 cup

2.1

Bok choy, cooked 1 cup

1.8

Bulgur, cooked 1 cup

1.7

Raisins 1/2 cup

1.6

Apricots, dried 15 halves

1.4

Veggie burger, commercial 1 patty

1.4

Watermelon 1/8 medium

1.4

Almonds 1/4 cup

1.3

Kale, cooked 1 cup

1.2

Sunflower seeds 1/4 cup

1.2

Broccoli, cooked 1 cup

1.1

Millet, cooked 1 cup

1.1

Soy yogurt 6 ounces

1.1

Tomato juice 8 ounces

1.0

Sesame seeds 2 Tbsp

1.0

Brussels sprouts, cooked 1 cup

0.9

Sources: USDA Nutrient Database for Standard Reference, Release 24, 2011

Recommended Daily Intake and Supplementation

The RDI for iron is 80% higher for vegetarians and is dependent on your age.  Children, adolescents and pregnant women have increased needs due to the rapid growth seen during these ages.  The values below are for vegetarian people only and reflect the increased need for iron in this population

Daily recommended intake of dietary iron for vegetarians

Children are at risk for iron deficiencyInfants (0-2 years): 19mg per day
Children (3-11 years): 18mg per day
Adolescent girls (12-18): 27mg
Adolescent boys (12-18): 19mg
Adult women (19-50): 32mg
Adult men (19-50): 15mg
Pregnant women: 48mg
Seniors (>50): 14mg 

Iron supplements should only be taken if blood tests have shown evidence of an iron deficiency or decrease in iron storage levels. Research suggests that a daily iron supplement is best for treating low iron, however frequency may be decreased to once or twice per week for prevention of deficiency in people with a history of low iron.

Iron supplements should be taken away from other minerals (especially calcium) since these may decrease the absorption of iron.  A source of vitamin C (500mg capsule) is also recommended to enhance absorption each time an iron supplement is taken.

Ferrous fumarate and ferrous sulfate contain the highest amount of elemental iron per mg with ferrous gluconate containing the least.  Ferrous gluconate, ferrous fumarate and ferrous citrate are well tolerated with fewer digestive side effects reported.

Constipation, darkening of the stool and digestive upset are the main side effects seen with iron supplements.  Supplements should be continued for three months beyond the resolution of iron deficiency anemia to replenish body stores of iron.

If you suspect you may have an iron deficiency, seek a blood test from your Medical Doctor or Naturopathic Doctor.

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

Goddard AF, James MW, McIntyre AS, Scott BB. Guidelines for the management of iron deficiency anaemia. British Society of Gastroenterology. 2005

M Amit; Canadian Paediatric Society, Community Paediatrics Committee. Vegetarian diets in children and adolescents. Paediatr Child Health 2010;15(5):303-314.

Hunt JR.  Bioavailability of iron, zinc, and other trace minerals from vegetarian diets. Am J Clin Nutr 2003;78(suppl):633S–9S

Stoltzfus RJ, Dreyfuss ML. Guidelines for the Use of Iron Supplements to Prevent and Treat Iron Deficiency Anemia. International Nutritional Anemia Consultative Group (INACG)