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The Empowered Woman’s Guide to Yeast Infections

If you have been reading my blog (yay you!), then you know my core mission is to empower women to demand more from their health. No more accepting mediocrity in our bodies and our wellness. You CAN feel better.

And the one condition I am constantly amazed that women are living with, without successful treatment, are yeast infections.

Ladies! You don’t have to live like this. If this is your first yeast infection, congratulations. You are going to learn how to deal with this right, the first time. If this is your third, or fourth, or fortieth – I am so glad you are here. Because we are going to get into some serious action-oriented information that you need to learn.

So let’s do this.

 

What is a Yeast Infection

A yeast infection is an overgrowth of yeast, usually Candida albicans that causes irritation to the vagina and vulva. Also known as VVC (vulvovaginal candidiasis), candida is most often self diagnosed and treated with over the counter creams and capsules.

While most women think of a yeast infection when they experience a thick, whitish discharge, only 20% of cases actually have this symptom.   The more common symptoms of a yeast infection are itching, swelling of the vulva and pain on urination (especially after peeing).

What is NOT a Yeast Infection

While most women self diagnose yeast infections, there are a number of imbalances that can occur in the lady garden that look like yeast infections, but aren’t.

Vaginitis – an infection of the vagina with inflammation. A yeast infection is a type of vaginitis, but this can also be caused by other infections, like trichomoniasis.

Vaginosis – the overgrowth of vaginal bacteria without inflammation. Most commonly caused by Gardnerella, BV (bacterial vaginosis) is incredibly common – even more so than yeast infections. But that is the subject of another article (coming very soon!)

Other conditions that are not yeast infections – contact irritation, allergic reactions, atrophic vaginitis, menopausal dryness, cytolytic vaginosis (Write this article too) and sexually transmitted illnesses like Chlamydia and gonorrhea.

What Your Doctor Isn’t Telling You About Yeast Infections

Yeast infections don’t need to be difficult to treat. They don’t need to be recurrent. The problem is that doctors aren’t offering complete solutions to women with yeast infections.

When you talk to your MD about yeast infections, most often you are told to take an over-the-counter antifungal medication that will kill the yeast. Sounds ok right? Well, no… not right.

Killing the yeast is important, there is no doubt about that. But killing the yeast does nothing to change the environment that the yeast was growing in. And since yeast is everywhere (yeast spores are airborne – you are going to be exposed to them both in your environment and from your digestive tract every day of your life) if you don’t change the environment, you’ll like just get another yeast infection.

The Empowered Approach to Yeast Infection Treatment

I’m going to present you with my empowered approach to fighting yeast infections. It takes a bit longer than the typical over-the-counter remedies – but it works a lot better. So if you’re ready to conquer candida, for once and for all, read on.

  1. Pay attention to pH

The healthy normal pH of the vaginal tract is around a 3.8-4.5. When you have candida (or BV), that pH can be increased above a 4.5. This occurs due to a change in the healthy bacteria, Lactobacillus, that should be the main bacteria in the vagina.

If you want to resolve your yeast infection, you need to pay attention to pH. If you optimize the normal, acidic pH of the vaginal tract, the yeast and nasty bacteria can’t thrive and the lactobacillus species can.

The best way to do this is with boric acid suppositories. Boric acid sounds scary – but remember, the vaginal tract is meant to be acidic. Using boric acid will restore the optimal pH and support the healthy bacteria populations. Made by a local compounding pharmacist, boric acid is simple to use and very effective.

  1. Eradicate the yeast

Ok. Yes, we do need to eradicate the yeast. But as I mentioned above, it can’t be the ONLY step in a successful yeast treatment. Most often I recommend using nature’s favourite antifungal – garlic – often combined with some caprylic acid (from coconut). Taken orally, or sometimes vaginally, these two are a powerhouse of antifungal activity.

But we don’t stop there. We also look at your diet. Yeast thrives in a high sugar environment, so I suggest avoiding all sugar (including dairy and bread products), alcohol and some fruits for at least a month while treating your yeast infection.

  1. Restore beneficial bacteria

yeast infection, candida, candidiasisWho hasn’t heard of the amazing benefits of probiotics? Those 300 trillion lovely little bugs that live in and on our body are a huge part of what makes us healthy (or not.)

In our lady garden, our boss bacteria is Lactobacillus. And imbalances in healthy levels of Lactobacillus are associated with BV and yeast infections.

The main source of bacteria for the vagina is from the “proximity exposure” to the exit of our digestive tract. So taking probiotics by mouth can be really effective for supporting healthy bacteria levels. Using vaginal probiotics is also highly recommended for yeast treatments, especially when using boric acid.

  1. Prevent recurrence

Eradicate yeast? Check.

Promote healthy pH? Check.

Lots of Lactobacillus? Check.

Now how do we stop this from happening again? Avoiding triggers that can lead to yeast infections – like a diet high in sugar, dairy and wheat, diabetes and unstable blood sugar, tight clothing and artificial fiber underwear (cotton ladies, cotton) is imperative. You can discuss with your ND whether you should embark on a longer “Candida Diet” – this isn’t necessary for everyone, but can make all the difference for some.

  1. Don’t accept mediocrity from your lady garden

I’ve said it before – and I’ll say it once more – yeast infections are not normal. And you don’t have to live with them. Now that you know better, I hope you will want better for yourself. And go out there and do it. You have been empowered – and I’m cheering you on.

Want a personalized treatment plan to get over your yeast infections?  Book in and let’s talk.  I’m ready when you are.

DUTCH test, hormone testing,hormone test, women's hormones, hormone health

DUTCH: Gold Standard in Hormone Testing

In my work with women’s health and hormones, one of the biggest areas of debate is hormone testing. Women are confused about when and how to test their hormones, and if I’m honest, a lot of doctors are confused as well. Which is leaving women under-diagnosed and under-treated for their very real (and very annoying) hormone imbalances.

But no more. Science has come a long way and right now we have the ability to test for hormones in ways that we never have been able to before. And women everywhere can benefit. So if you’ve ever wondered, “Do I have a hormone imbalance?”, now we can easily answer that question.

The DUTCH Test

Hormone testing with the DUTCH testDUTCH is an acronym that stands for Dried Urine Test for Comprehensive Hormones. It is a simple, but sophisticated test that looks not just at your hormones, but how your body processes and metabolizes them.

The DUTCH test looks not just at your reproductive hormones (although it does look at those quite thoroughly), but it also looks at your stress hormones, your androgens (male pattern hormones), your melatonin and the new DUTCH test also looks at organic acids – markers for mood and nutritional balance in the body.

8 Reasons the DUTCH Test is the Gold Standard for Hormone Testing

  1. Simple collection

Nothing is easier than peeing on a piece of filter paper. (Ok… some people might get a little pee on themselves, but still… is that the worst thing that can happen to you today?)

  1. In depth hormone levels

If you have a question about your hormones, the answer is likely to be found in the DUTCH test. While your Naturopathic Doctor may still recommend blood testing for hormones like thyroid hormone, FSH or LH, just about every other hormone is covered in the DUTCH test.

  1. Metabolism matters

Hands down, the reason the DUTCH test is the best, is that it measures metabolites. The absolute level of your hormones matter – but what can matter more is what your body does with those hormones. This is metabolism – does your body turn testosterone into nasty acne-promoting 5a-DHT?? Does your body turn estradiol into DNA damaging 4-OH estrone? Are you healthfully metabolizing and eliminating estrogen from your body? The DUTCH test can tell you.

  1. It’s all about those curves

Not every hormone has stable levels over the entire day. In particular, our primary stress hormone, cortisol, and its metabolite cortisone, have a curve that changes over the course of the day. Blood tests only give us a single snapshot of your cortisol levels, but the dried urine test gives us not only the total levels of cortisol and cortisone, but also the curve – how those levels change over the day. This is some VALUABLE information for people who are struggling with stress, fatigue, anxiety, decreased libido, trouble sleeping and insomnia.

  1. Balanced estrogen

Estrogen is one of the most important hormones in our bodies, and it has so many benefits for our health, but it can also have negative impacts if it is not in balance.

Typical hormone testing for estrogen looks just at estradiol, the dominant estrogen in the body. But that only tells us such a small bit of information. If we want to balance our estrogen, and prevent complications of estrogen dominance, then we want to understand how our body copes with our burden of estrogen. What metabolism pathways does our body use? Are those the best pathways?

If you are considering bioidentical hormones (BHRT) for perimenopause, or menopause symptoms, then the DUTCH test is highly recommended at the initial visit to understand how you will metabolize the hormones.

  1. Androgens and acne and hair health

In my work with women, no one condition is more loathed or baffling than acne. WTF, am I right ladies? How did we reach our 30s and still have to deal with acne?? Often it’s an issue of androgen metabolism. But typical hormone testing just looks at the amount of testosterone being made, and not what your body is doing with it. If your body is sending more testosterone towards the DHT metabolites, you will have more acne and possibly hair loss (and chin/ upper lip hair growth!) The DUTCH test will tell you if this is happening – and then we can talk about what to do about it!

  1. Melatonin

If you are having difficulty sleeping, knowing your melatonin levels is amazing information to have. But not only those with insomnia or sleep challenges should know their melatonin levels. Melatonin is also a powerful antioxidant in our bodies, and optimal levels of melatonin have been found to reduce the incidence of hormonal cancers (including breast cancer). No other hormone test looks at melatonin, but the DUTCH test does.

  1. Organic acids

Natural treatments and testing for depression and anxietyA new addition in 2018 to the DUTCH test is the 6 OAT (organic acid tests). I’m so excited for this new information!

Three new markers for neurotransmitters – to help us understand your mood. If you struggle with depression, anxiety or insomnia, this information can be very significant. If you have tried antidepressants without benefit, your organic acid markers for specific neurotransmitters, like serotonin, may tell you why.

Additionally there are three new markers for nutritional levels – looking at your B6 and B12 metabolism as well as your glutathione status. If you are concerned about weight gain or inflammation as part of your hormone imbalance, now we may be able to identify why.

The 1 Reason I don’t love DUTCH Testing

  1. The test results are ugly

I know. Such an aesthetic issue. But the test results are ugly – seriously. The results are clear. The information is valuable. But the results look a lot like a airplane dashboard, and some patients find this overwhelming. So take the time to talk through the results with your ND to understand what they mean for you.

Toronto, naturopath, doctor, naturopathic doctor, holistic, functional doctor

Next Steps

If you are interested in DUTCH testing, I suggest booking a 15 minute complimentary meet and greet to discuss the details. It is an amazing, useful, sophisticated test. But it’s not the right test for everyone. So let’s talk and see if it is the right test for you.

Dr. Lisa

Further Reading

https://dutchtest.com

https://articles.mercola.com/sites/articles/archive/2016/05/08/dutch-hormone-test.aspx

 

When it’s NOT PCOS: Non-Classic Congenital Adrenal Hyperplasia

A woman, let’s call her Nicole, enters my office with a concern of acne. Acne in an adult woman is, unfortunately, not uncommon these days. After spending some time talking to Nicole we find that she also has hair loss from her scalp, and hair growth on her chin as well as irregular periods.

If you’re familiar with PCOS you may recognize these as the most common symptoms of PCOS – irregular (or absent periods), acne and hair growth on the face or hair loss from the scalp.

But it wasn’t PCOS for Nicole. It was something else.

Non-Classic Congenital Adrenal Hyperplasia

Non-classic congenital adrenal hyperplasia (NCAH) is a condition that usually develops around the age of puberty and can impact both boys and girls (this article is just about the girls – sorry guys!)

NCAH is an inherited condition where a person does not make enough of a specific enzyme, 21-hydroxylase, that converts the hormone progesterone into cortisol. When this enzyme doesn’t work more progesterone is shifted into testosterone and levels of testosterone and other androgens increase.

Why Does NCAH Look Like PCOS?

Both PCOS and NCAH have symptoms that are the result of high androgens – testosterone, androstenedione, and dihydrotestosterone. However, the source of the high androgens is different.

In PCOS the elevated androgens come from overstimulation of the ovaries by follicle stimulating hormone (FSH), without the corresponding ovulation – leading the ovaries to continue to produce large amounts of testosterone over time.

In NCAH, the testosterone comes from the conversion of progesterone (and 17-OH progesterone) into androstenedione and subsequently testosterone.

In either case, high testosterone in a woman leads to oily skin, acne, facial hair, and scalp hair loss. Not such a pretty picture.

So, is my PCOS actually NCAH??

There are some warning signs that your PCOS may actually be NCAH.

  • Did your puberty start early – before 10 years of age? Or was it significantly delayed – after 15 years of age?
  • Did you have premature development of pubic or underarm hair?
  • Are you shorter than average height for an adult?

All of these findings are more common in NCAH than in PCOS.

But ultimately the diagnosis of NCAH requires a blood test.

17-OH Progesterone Testing

The first test for non-classic congenital adrenal hyperplasia is a 17-OH progesterone test. If your levels of this test are elevated, then you most likely have NCAH. While this test is routinely done in newborns, the non-classic variant can be missed until puberty.

If the 17-OH test is positive then a follow up test, known as the ACTH stimulation test, is done to confirm the diagnosis.

As NCAH is the most common autosomal recessive disorder in humans (you have to have two mutated copies of the gene to get this condition) – impacting around 1 in 100 people, this test is highly recommended if you have PCOS – especially if you don’t seem to fit the typical PCOS picture.

Moving Forward

NCAH, for some women, causes little to no difficulty. Other women have issues with abnormal hair growth/ hair loss or acne that can be difficult to treat. Other women have issues with infertility. It is a variable condition. Talk to your Naturopathic Doctor or Medical Doctor if you think your PCOS may actually be NCAH, and learn about your diagnosis and treatment options.

 

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.

 

Pregnancy and Thyroid Health

Pregnancy is a time when we expect a lot of hormonal changes – but not every woman is aware of the changes that can occur in her thyroid function – and what that can mean for both her health, and the health of her baby.

A Brief Introduction to your Thyroid

Your thyroid is a hormone-producing gland, located at the front of the neck. It produces thyroid hormones (T4 and T3) that regulate our metabolic rate – our ability to make energy in our cells.

Thyroid Hormone Changes in Pregnancy

During pregnancy the body has a significant increase in metabolic activity – a lot of energy is required to make a baby! As such, the need for thyroid hormone increases. Women need approximately 40% more thyroid hormones during pregnancy to sustain the increases in energy needed for a healthy pregnancy.

Many women with thyroid disease are not immediately identified in pregnancy, as many of the symptoms of hypothyroidism (low thyroid function) are the same as symptoms of pregnancy. Weight gain, depression, fatigue, constipation and dry skin are all common in pregnancy and are also signs of an under-performing thyroid gland.

If you know prior to pregnancy that you have an underactive thyroid (half of people with hypothyroidism don’t know it), then increasing your thyroid medication soon after a positive pregnancy test is recommended. An increase in the medication dose of 25-40% is suggested for most women.

An underactive thyroid, challenged by the increased energy demands in pregnancy, may also be exacerbated by the increased clearance of iodide by the kidneys in pregnancy (all those increased trips to the bathroom have consequences as well!) Many prenatal supplements still do not contain adequate amounts of iodine to address this issue, worsening an already delicate hormone balance in pregnancy.

Consequences of Thyroid Disease in Pregnancy

Hypothyroidism in pregnancy is a serious health concern. Recurrent miscarriages have been found in women with even mild and asymptomatic thyroid disease. Increases in fetal death, birth defects, premature birth, low birth weights, placental abruption and intellectual disability have all been linked to hypothyroidism in pregnancy, especially in early pregnancy.

Hypothyroid is not the only thyroid concern that is problematic in pregnancy. The presence of autoimmune antibodies against the thyroid (TPO or anti-TG) can also increase the chances of miscarriage – in some studies doubling the risk of an early miscarriage.

Thyroid Testing in Pregnancy and Pre-Conception

Unfortunately, thyroid testing is not standard care for women who are trying to conceive, or who are pregnant. It is not even standard for women who have experienced an early miscarriage, in spite of the association of hypothyroidism and autoimmune thyroid antibodies and miscarriage.The demand for thyroid hormone in pregnancy increases most in the first half of pregnancy – especially in the first 6-12 weeks. This means we need to be testing women sooner – ideally before pregnancy, and certainly after a positive pregnancy test. Most experts believe that testing should be done before 9 weeks gestation – within the first month after a positive pregnancy test.

More comprehensive thyroid testing should also be offered to women trying to conceive, or who are pregnant. A simple TSH is not enough to fully assess the thyroid – autoimmune antibodies, T3 and T4 levels should also be tested.

And please keep in mind, the lab ranges for “normal” on thyroid testing are not the same as those that are optimal for pregnancy. Even mild or asymptomatic hypothyroidism, or any elevation in thyroid antibodies, can increase risk for an unsuccessful pregnancy.

If your doctor is unwilling to run these tests for you, speak to your Naturopathic Doctor. They can advocate for you, or run the tests to ensure you are getting the optimal support you need both before, and during, pregnancy.

The risks of not identifying a thyroid condition in pregnancy are significant. Don’t let a lack of knowledge, a lack of testing, or a lack of an appropriate diagnosis impact your pregnancy. Speak up, get the testing, and have a healthy, happy pregnancy.

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

Alexander EK, Mandel SJ – Diagnosis and Treatment of Thyroid Disease During Pregnancy. Endocrinology: Adult and Pediatric 7th Ed, 2016. Chapter 84; 1478-1499.

 

 

 

Is my IBS actually SIBO?

Gas, bloating, abdominal pain, diarrhea, constipation – present to your medical doctor with any of these symptoms and you’ll likely get a diagnosis of IBS – irritable bowel syndrome. But what if it’s more than that? What if rather than having a cranky digestive tract you actually have a bacterial imbalance in your small intestines? What if you have SIBO?

What is SIBO?

SIBO stands for small intestine bacterial overgrowth, a condition where abnormally large numbers of bacteria (both the good and bad kind) are present in the small intestine. SIBO is a very common cause of IBS-like symptoms – studies have shown SIBO to be involved in between 50-84% of IBS cases. More importantly, when treated for SIBO, a 75% reduction in IBS symptoms has been found. For people who have been suffering for years (or decades!) with IBS symptoms, a proper diagnosis of SIBO can be life-changing.

Symptoms

While most people who experience digestive issues are given a diagnosis of IBS, the symptoms of SIBO are so similar that I recommend every patient who has been told they have IBS be tested for SIBO. Symptoms of IBS include:

  • Gas and bloating (often causing visible distention of the abdomen)
  • Flatulence (farting) and belching (burping)
  • Abdominal pain, cramping or general discomfort
  • Constipation or diarrhea (or both!)
  • Heartburn
  • Nausea
  • Nutrient deficiencies (due to malabsorption – vitamin D, B12, K)

The bacterial overgrowth in SIBO can cause significant gas and bloating – if you are experiencing severe gas or bloating, SIBO testing should be considered. With healthy normal bacteria levels, a single ounce of milk will cause about 50cc of gas to be created. With SIBO, that same amount of milk will cause up to 5000cc of gas to be created! And that gas has to go somewhere – filling the intestines and causing pain, or being released as gas and burping.

Many conditions may also be associated with SIBO, with the additional symptoms of those conditions being present. Some of those conditions include:

  • Hypothyroidism
  • Gallstones
  • Crohn’s disease and inflammatory bowel disease
  • Lactose intolerance
  • Diverticulitis/ diverticulosis
  • Fibromyalgia
  • Chronic pancreatitis
  • Lactose intolerance
  • Celiac disease
  • Restless leg syndrome
  • Rosacea
  • Diabetes

What Causes SIBO?

In our bodies we support a population of around 300 trillion bacteria. Living mostly on our skin and in our large intestine, these bacteria are powerful supporters of healthy human function. Producing vitamins like vitamin K and B12, producing neurotransmitters like serotonin, and regulating the function of our immune system – these bacteria are essential for optimal health.

SIBO occurs when the bacteria that should be in our large intestine migrate upwards into our small intestine. There they produce gases and disrupt nutrient absorption, leading the symptoms often attributed to IBS.

There are some specific triggers that can lead to this movement of bacteria into the small intestine. Some of those triggers include:

  • A stomach flu or food poisoning
  • Low stomach acid (or use of antacids)
  • Prior bowel surgery
  • Use of antibiotics (especially multiple courses)
  • Moderate or high alcohol consumption (greater than one drink per day for women or two drinks per day for men)
  • Use of birth control pills

One of the organisms involved in SIBO, Methanobrevivacter smithii has been linked to obesity in humans

Clues to SIBO

There are some clues that your IBS may in fact be SIBO. If you answer “yes” to any of these questions, you should invest in SIBO testing now.

  1. Did your digestive symptoms start, or become worse, after a bout of the stomach flu?
  2. Have you experienced short term improvement in your symptoms after taking an antibiotic?
  3. Do your symptoms get worse when taking a probiotic or prebiotic supplement?
  4. Does eating a high fiber diet worsen constipation or IBS symptoms?
  5. Do you have celiac disease that has not sufficiently improved following a gluten-free diet?
  6. Have you been diagnosed with an iron deficiency, despite having an iron rich diet?
  7. Do you have IBS symptoms and take antacids more than once per month (including Tums, Rolaids, Nexxium or Prilosec)?
  8. Do you experience gas that has a strong “rotten-egg” odour?

Diagnosis

The overgrowth of bacteria seen in SIBO can be identified through a breath test. The bacteria produce high amounts of hydrogen, hydrogen sulfide, or methane gas. These gases are not produced by human cells, but only through the action of bacteria on carbohydrates in our intestines.

The most common (and effective) test for SIBO is a combined hydrogen/methane breath test. This test is readily available from your Naturopathic Doctor. This is the only test for SIBO – stool tests will not help to diagnose SIBO.

Next steps

If you suspect you may have SIBO, you should see your Naturopath for appropriate testing. Once a diagnosis has been made you can embark on a treatment plan that may finally resolve your symptoms and get you back on the path to optimal health.

The treatment of SIBO is multifaceted and individualized for each person. Some of the key areas we focus on are supporting small intestine motility, optimizing digestive acids and enzymes, healing the lining of the digestive tract, eradicating biofilm and promoting healthy bacterial balance in the large intestine. Addressing the lifestyle and diet for long term prevention of recurrence is also important. Discontinuing medications, like antacids and proton pump inhibitors that encourage SIBO must also be considered.

You don’t have to continue to suffer. Digestive health is essential for optimal health. Get yourself tested, and get on the path to wellness 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 Types

Syndrome of PCOS

Polycystic ovarian syndrome (PCOS) is condition impacting up to 1 in 10 women in North America. PCOS is a “syndrome” – a medical term for a condition that can have different symptoms in different people. In PCOS we can see a wide variety of presentations. Some women have many symptoms, while others have few. Some of the symptoms that can present in PCOS are:

  • Irregular periods
  • Long time between periods (prolonged cycles)
  • Infertility
  • Hair growth where you don’t want hair (chin, upper lip, neck, chest, back, breasts, buttocks)
  • Hair loss where you do want hair (scalp)
  • Weight gain
  • Oily skin
  • Acne

Diagnosis of PCOS

Ultimately the diagnosis of PCOS is based on the Rotterdam criteria – you must have 2 of the 3 criteria (irregular periods, cysts on your ovaries, signs or laboratory evidence of elevated androgens) to be diagnosed. To learn more about diagnosis, read this article by Dr. Lisa on PCOS Diagnosis.

As a Naturopathic Doctor I think we should move beyond mere diagnosis, and really get to the underlying causes of PCOS. And this is where the PCOS Types come into play.

Types of PCOS

Type 1: Insulin-Resistant PCOS

The classic presentation of PCOS – a woman experiencing weight gain, irregular or no periods, acne and facial hair – is represented by Type 1 PCOS, a condition associated with insulin resistance. The lack of response of the ovaries to insulin leads to a hormonal cascade that results in increased testosterone levels, the underlying cause of those unfortunate symptoms.

Women with insulin resistant PCOS have an increased risk of developing diabetes and depression – two other conditions associated with insulin resistance.

Treatment for insulin resistant PCOS involves improving the body’s response to insulin. Supplements such as inositol, chromium and cinnamon can be helpful. Spearmint tea can help to decrease testosterone levels and reduce facial hair growth and acne.

Weight optimization and following the PCOS Diet can also be part of this process. However, please keep in mind that not all women with insulin resistant PCOS are overweight. Slender women can also have insulin resistance as a result of their diet.

Type 2 PCOS: Non-Insulin Resistant PCOS

What once was a rare occurrence, I am now seeing many more women in my practice with non-insulin resistant PCOS. This can be caused by a number of different causes including:

  • Inflammation
  • Immune system challenges (including autoimmune diseases)
  • Vitamin D deficiency
  • Iodine deficiency
  • Thyroid hormone imbalance
  • Stress
  • Low dose chronic environmental exposures
  • Discontinuation of the birth control pill
  • A diet inconsistent with your body’s individual biochemistry

This type of PCOS requires more investigation and understanding that the classic insulin-resistant PCOS. Often I will run more extensive blood work than is typically offered to a woman with PCOS. Depending on the woman I may look at nutritional levels, hormone balance (prolactin, thyroid, LH, progesterone, cortisol, DHEA, testosterone), autoimmune antibodies, inflammatory markers, and food sensitivity testing.

The approach to managing non-insulin resistant PCOS is a personalized medical approach. It is essential that we uncover the root cause of the PCOS and address it directly with an approach that encourages balance and optimum function. Often women respond quickly once the cause has been identified and balance is restored.

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.

 

Bitch Redux

In my work in women’s health I see a lot of conditions impacting the lady garden, endometriosis, PCOS, fibroids, cervical dysplasia, yeast infections and UTIs. But the one issue a lot of the women in my practice complain about is bitchiness. It might not be a medical diagnosis, but it impacts up to 80% of women at some point during their monthly cycle.

Women’s Emotions

Women have evolved to have immense sensitivity, and their emotional variations allow them to be more responsive to the environment, people and connections important to them.

Women are naturally more empathic and intuitive than men (of course acknowledging the great diversity of individual personalities). Women have always been the caretakers, the gatherers, the life-givers. Women rely more on social relationships for their survival, and the survival of their children and communities. Women have great emotional intelligence, because they need to be able to intuit and empathize with those around them – their children’s needs, their community’s goals, their partner’s intentions.

Women’s Brains

Women’s brains develop different to men, hardwiring us to feel more deeply, be more attuned to the emotional states of others, and be more reactive to the needs of those around us. At 8 weeks gestation, the testes become functional and the resulting surge of testosterone kills neurons in the communication centre of the brain. The testosterone instead develops more neurons for action, aggression and sexual drive – ultimately taking up about 2.5 times the space in men’s brains than women’s.

In women’s brains more space is allotted for language, hearing and memory. The memory center, the hippocampus, is larger in women, allowing those early female gatherers to remember where to find the food. The insula, thought to be the seat of self awareness, empathy, and interpersonal relationships, is also noticeably larger in women. This may lead to an increased intuition, or gut feeling, in women.

Women’s Hormones

Women’s hormones DO make them more moody. For women being fixed and rigid doesn’t lend itself to survival. Our emotionality is our strength – we may not be as physically strong as men, we rely more on our emotional connections and strength of connections, community and family.

Unlike men, whose hormone production spikes at puberty and remains fairly stable across their lifetime, women’s hormones ebb and flow over a monthly cycle and wax and wane over their reproductive years.

At the beginning of our menstrual cycle, at the onset of our bleeding, estrogen levels climb to prepare an egg for ovulation at midcycle. Estrogen production is strongly linked to serotonin production – and as estrogen goes up, so too does serotonin.

As estrogen continues to climb to the midcycle peak, most women note a positive mood state. During this time our biology encourages us to be more social, to connect to our tribe, more confident, to meet people and more alluring, to try to find a mate to conceive a baby with.

Estrogen acts as a stress hormone, or an anti-stress hormone. Making us more likely to brush off things that at other points in our cycle may provoke a significant response.

At midcycle estrogen levels are at their highest, along with dopamine and oxytocin. This encourages pro-social, trusting behaviour, and we are more generous and connected to others in our social network. We also talk more and are more interested in intimacy than at any other time of the monthly cycle.

Immediately after ovulation, our estrogen levels start to decline, but the rise in progesterone catches us before our moods crash. Progesterone doesn’t increase serotonin levels like estrogen does, but it supports GABA production, leading to a sense of calm and low anxiety that persists for about 10 days while progesterone levels are high.

All hell breaks loose during the final 3-7 days of the menstrual cycle however, with estrogen levels at a low, and progesterone levels steeply declining. Women during this time are more depressive, more cautious – a way for nature to keep us from harm during a time when we may be pregnant without knowing it.

The low estrogen also makes us less resilient, experience more physical pain, more emotionally sensitivity, and makes us more likely to react or respond to triggers that we would ignore during our high estrogen first half of the cycle. It’s not that we have more stress – we’re just way more likely to call it what it is and not stand for any shit.

Estrogen is essentially the “whatever you want honey” hormone – you are so much more willing to give to others and sacrifice your own needs when estrogen levels are high. But when those levels drop we are more likely to react and share our opinions – good or bad. It is not that we are reacting to things that aren’t really there – we’re reacting to things that upset or anger us – we just might ignore them at other times. If you feel underappreciated, overworked, or overwhelmed, or that you’re not in balance with your partner – it’s probably all true.

Bitch Redux

I want to encourage women to recognize the power in our hormonal fluctuations – our mood changes are adaptive – they help us seek out relationships, build connections, and preserve our energy. The mood changes that occur during our premenstrual phase are normal, and temporary. I want women to reclaim our natural hormone and mood fluctations, and be empowered by our emotions, rather than struggling against them.

My recommendation is to learn your natural fluctations and use your bitchiness as a superpower. Track your cycle – using any number of excellent free apps – and plan your month accordingly. Plan for presentations, meetings, anything requiring verbal skills for your first half of the cycle (the closer to ovulation the better! Your personality is magnetic when you’re near ovulation!) Have a task that requires fine motor skills – an intricate art project or rewiring your house? Keep that to the first half of the month as well.

Leave the tasks best left for your OCD-self for the last month of the cycle. I think most women probably read The Life-Changing Magic of Tidying Up during the last week of their cycle. So put “clean out the kitchen cupboards” on your list for the premenstrual week (maybe stay out of your closet though – many women feel less appealing during their premenstrual week and this could be a disastrous task.) Your pain tolerance is also lowest during your premenstrual phase – so skip the dentist or your tattoo appointment and get a mani-pedi or skin care facial instead.

Think of your PMS as a time to spend in reflection and personal contemplation. Your intuition is at its peak in the week before your period, so take time to do a mental health inventory – are you doing what you want? Are you where you want to be? Pay attention to the things you are critical about during your premenstrual phase – these thoughts are probably a lot more valid than you might want them to be. Write down the things that upset you/ anger you/ send you into a whirling passion of emotions and act on them in the beginning of the next cycle when you’re feeling energized and empowered again. Harness your bitchiness, it could end up being your greatest power.

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 the Pill

There is no doubt that the birth control pill was a huge player in the feminist revolution. First released in 1960, the pill allowed women to delay pregnancy and focus on their career, transforming the lives of women and society. While the pill may be a political powerhouse, and be effective at preventing pregnancy, my belief is that it is being overprescribed, and women are under-educated on the impact that the pill can have on their health.

This article will 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 so that you can make an informed choice as to whether this medication is the right choice for you.

Problems with the Pill

  1. The Pill Depletes Nutrients

One of the biggest problems with the pill is the nutrient deficiencies that result from use. From B vitamins to essential minerals, the pill changes the absorption, utilization and metabolism of a number of different nutrients. These nutrient depletions are the underlying cause of many of the negative side effects of the pill – things like weight gain, moodiness, fatigue and blood clots. You can read all about the nutritional problems with the pill in this article.

  1. Weight gain

The estrogen in birth control pills can cause an increased appetite and fluid retention, leading to weight gain, especially in the first few months on the pill. Long term weight gain on the pill is more likely due to the decreased levels of B vitamins, necessary for carbohydrate and fat metabolism (i.e. burning fat for energy).

  1. No glory for our guts

The pill is known to alter the balance of healthy bacteria in our guts. Estrogen affects gut permeability (a risk factor for autoimmune disease) and bacteria balance, a condition known as dysbiosis. Healthy bacteria are incredibly important for our overall health – especially our immune, mood and digestive health. The pill has been linked to symptoms of gas, bloating, IBS, and an increased risk of Crohn’s disease in women with a family history of the digestive condition.

The change in healthy bacteria balance, combined with the estrogen in the pill, also makes women more susceptible to vaginal and digestive yeast infections. If you get frequent or recurrent yeast infections, or significant gas or bloating symptoms, consider if your pill may be part of the problem.

  1. Moodiness

Any woman can tell you that hormones can have a significant impact on your mood. The rises and dips in estrogen and progesterone that occur over a woman’s monthly cycle can lead to moods and behaviours that foster relationships, encourage sexual intimacy, and make women weepy, emotional and volatile. While some women on the pill notice very little difference in their mood states, other women find their normal emotional states become heightened in intensity and more difficult to manage. The reasons for this are very individual – some women don’t tolerate the high levels of estrogen and others find the high progesterone problematic. In either case, if the pill makes you moody switching to another pill is unlikely to help.

  1. Blood clots

Possibly the most well known side effect of the pill, the risk of blood clots is highest in women who are obese, are smokers or who have a family history of blood clots. The estrogen in the birth control pill is the most likely culprit, increasing the production of clotting factors and increasing a woman’s risk of blood clots by three-to-four fold. Deficiencies of key nutrients can also contribute to an increased risk of blood clots, most notably vitamin B6, vitamin E and magnesium – all of which are depleted by the pill.

  1. Thin endometrial lining

The endometrial (or uterine) lining is necessary for a successful implantation and pregnancy. In women wanting to have a family, long term use of oral birth control pills could thin the endometrial lining, leading to difficulty conceiving or maintaining a pregnancy. The underlying cause of this change is thought to be a down-regulation of estrogen receptors in the uterus, resulting from long term use of synthetic progesterone. The upside to this situation, is that this same mechanism is thought to be the reason why the pill reduces the risk of endometrial cancer.

  1. No sex drive

Never mind a thin endometrial lining if you can’t get up the urge to have sex at all. Many women report a low libido as a major issue they have with taking the pill. The pill lowers androgens and the lowered testosterone is likely responsible for the lack of sex drive. Around ovulation women typically experience a small, but significant, testosterone surge, causing them to seek out sex. On the pill you don’t experience this testosterone surge and your urge for sex can all but dry up. On a positive note – this decrease in testosterone is the reason why the pill can improve acne. But there are other ways to clear acne than giving up your lusty libido.

  1. Ignoring Mr. Right

Some of the most intriguing research on the pill surrounds a woman’s decision making around possible partners. Women who are on the pill tend to be attracted to more masculine, macho men with more ‘manly’ physical characteristics, and ignore men with softer, more ‘feminine’ features. Dr. Julie Holland, in her book Moody Bitches, refers to this as the “dad-or-cad” dilemma – women on the pill are more likely to be attracted to the bad-boy, rather than the more sensitive man who may be more acceptable as a long term partner and father to her children. Dr. Holland suggests it might be a good idea to get off the pill if you’re entering the dating pool, to prevent later regrets!

As if that wasn’t enough, another study found that women on the pill tend to seek out men with more genetic similarities to themselves, increasing their risk of miscarriage and genetic issues in their offspring. Women off the pill tend to choose men that are more genetically dissimilar – a pairing that tends to result in healthy pregnancies, happier relationships, more satisfying sex, and an increased likelihood of female orgasm.

  1. Masks symptoms

One of my biggest concerns with the pill is that it is used by conventional doctors as a band-aid for every female reproductive issue. Got PCOS? Take the pill! Got endometriosis? Take the pill! Got fibroids? Take the pill! PMS or menstrual cramps? Take the pill! Perimenopausal? You get the pill too! In no way does the pill address the underlying issues of these women’s health issues. The pill just provides a steady state of synthetic hormones, suppressing and masking the symptoms of the underlying imbalance. When you get off the pill you are no better than when you started – but you are older. And if you want to try and start a family you still have to address the underlying imbalance. The use of the pill as a way to suppress and deny the imbalances in women’s hormones is a disservice to women and I deplore it.

  1. The pill is a carcinogen

Ok. I get it, this sounds scary. But it’s true. The International Agency for Research on Cancer includes oral birth control pills as a carcinogen on its list of known human carcinogens. Studies have shown that birth control pills can increase the risk of breast cancer, cervical cancer and liver cancer. It can reduce your risk of ovarian and endometrial cancers, however. In general I’d suggest using the pill for as short a duration as possible and consider other forms of contraception for the majority of your reproductive years.

We have to keep in mind that the pill is not without problems. It contains synthetic hormones at levels much higher than our body produces on its own. Some of the side effects like acne, breast tenderness, or moodiness might be manageable, but I think women need to be empowered with knowledge to decide if the pill is the right choice for them.

If you have concerns about using the pill, want to balance your hormones naturally, or discuss natural forms of non-hormonal contraception, book an appointment now. Your hormones are in your hands – strive for hormone harmony!

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.