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Endometriosis and Fatigue

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

Fatigue and Endometriosis

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

            “We’re all tired”

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

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

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

            “I could give you some Ambien…”

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

Managing Fatigue in Endometriosis

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

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

Disclaimer

Fatigue is a common symptom of endometriosis.

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

Select References

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

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

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

Endometriosis Staging

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

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

Endometriosis Staging

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

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

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

            Stage I – Minimal endometriosis (less than 5 points)

            Stage II – Mild endometriosis (6-15 points)

            Stage III – Moderate endometriosis (16-40 points)

            Stage IV – Severe endometriosis (>40 points)

*Follow the link for the exact point calculations. 

Concerns with Staging Endometriosis

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

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

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

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

Disclaimer

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

The Most Important Test for Preventing Miscarriage

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

Lack of Lab Testing

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

Comprehensive Testing

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

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

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

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

Getting Tested

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

Disclaimer

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


Going Grey

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

Aging Grey

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

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

Grandma Was Great, and Grey

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

Premature Greying

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

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

Contributing to the Grey

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

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

What To Do About Grey Hair

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

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

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

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

Disclaimer

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

How to Select a Naturopathic Doctor

I believe that women need the medicine that Naturopathic Doctors offer.  I believe that giving women the knowledge they need to make healthy decisions for their health, and the health of their families, is one of the most powerful ways we can empower women. This is the entire reason my website exists – to share knowledge and empower women.

But I can’t be everywhere.  And I can’t treat everyone.  As a Naturopathic Doctor I am a regulated health care professional and can only practice in jurisdictions where I am licensed (Ontario, Canada).  Every week I receive emails from people across Canada and around the world who want to find someone like me.  The great news is that there are many wonderful Naturopathic Doctors out there who are making huge impacts on the health of their community.  And you can find one in your area.

How to Select a Naturopathic Doctor

The Basics

1. Do they have a degree in Naturopathic Medicine?

In North America there are only seven accredited schools where a Naturopathic Doctor can obtain a degree.  Only two of these are in Canada.  You can check the schools on the website for the Council for Naturopathic Medical Education (CNME).

2. Are they licensed to practice in the province or state where you live?

Naturopathic Medicine is not regulated the same in every province or state.  In fact, only 5 provinces (Ontario, British Columbia, Alberta, Saskatchewan and Manitoba) currently regulate Naturopathic Doctors.  Many states in the USA also regulate Naturopathic Medicine, while others are still seeking regulation.  (Click here to check if your state is regulated).

Regulation is important to ensure the safety of the public – if you are in a regulated area only see a Naturopathic Doctor who is licensed to practice in that area.  If you are not, consider finding a Naturopathic Doctor who is licensed to practice in a regulated area.

The Right Fit

3. Do they have a practice focus? 

Naturopathic Doctors are primary care physicians – trained to support a wide variety of health care conditions and concerns.  However, many Naturopaths choose to focus their practice on treating a specific concern or population.  Ask your potential ND if they have a practice focus and see if it is inline with the concerns you are seeking care for.  You don’t want to see a cancer-focused Naturopathic Doctor if you are seeking care for PCOS.

4. Do they have any additional certifications or training?

The education of Naturopathic Doctors should not end when they graduate from naturopathic medical school.  There are additional certifications and associations that Naturopathic Doctors can obtain that can enhance the services they offer.  Examples include bio-identical hormone prescribing, IV micronutrient therapy, perinatal, cancer, or pediatric associations.

The Best Practices

5. What types of assessments or testing do they offer in their practice?

One of the core tenets of Naturopathic Medicine is to treat the root cause.  How is your Naturopathic Doctor going to help to uncover the root cause of your symptoms?  Do they offer the highest level of functional tests in addition to standard blood tests? Do they do mostly energetic testing?  Will they review lab tests from your Medical Doctor? How do they decide what tests may be necessary for you?

6. Do they incorporate evidence based information and research into their treatment plans? 

The body of research on naturopathic medicine is growing every single day.  How does your Naturopathic Doctor stay up to date on research in their practice?  Do they incorporate both modern research and traditional knowledge into their treatment plans?  Patients are often surprised by the amount of research we can provide on the treatments we are suggesting for their care!

7. Will they work integratively together with your current health care team?

Integrative Medicine is choosing the best of all forms of medicine with the sole purpose of improving patient outcomes.  ~ Dr. Lisa

I think the medicine of the future will be more patient-centered, with all different types of health care providers working together to improve the health of individuals and their families.  I love working with Medical Doctors, physiotherapists, psychotherapists, nurse practitioners, chiropractors, osteopaths, massage therapists, and many other health professionals.  I truly believe this approach benefits everyone, most importantly my patients.

8. What types of therapies do they use in their practice?

Naturopathic Doctors are trained in a number of different therapies, from acupuncture to herbal medicine, nutritional supplementation and homeopathy.  What therapies does your Naturopath use, and why?  Personally I don’t use a lot of homeopathy in my practice because there isn’t a vast body of research supporting its use.  I focus on the research based treatments of nutritional and botanical medicines.  Discuss what your Naturopath is using and see if it resonates with what you’re looking for.

9. How much experience does the Naturopathic Doctor have?

There are many more important considerations than the number of years a doctor has been in practice, but it is something to discuss when meeting a Naturopath for the first time.  You don’t necessarily want to be someone’s first patient with your health concern.

10. Do you trust them, feel listened to, and comfortable with them?

In my mind, this is one of the most important considerations.  Ideally you are building a long term relationship with your Naturopathic Doctor.  Consider the so-called “soft traits” like personality, approachability, empathy and trust when deciding on your Naturopath.  This can be the make or break factor in selecting your ND, and I encourage you to trust your gut.

To make things easy for you, I’ve made a pdf with all these suggestions.  Bring it along when meeting your Naturopathic Doctor for the first time.  Most NDs offer a free 10-15 minute meet and greet appointment – I highly recommend taking them up on this.  Take the time to choose the best ND for you, and you will benefit immensely from the investment!

How to Select an ND

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.

 

 

Mummies & Dehydration: Supernatural Health Series

Water, water everywhere.  With 71% of the earth being covered in water, and around 60% of the human body being water, there is no doubt that water is one of the most important elements of health – health of the body and health of our environment.

But what about the health of mummies?  No one is more prone to severe dehydration that a mummified person or animal.  In fact, a lack of water is necessary for the mummification process.

So what is a health seeking mummy to do?  Let’s look at general guidelines for water consumption in humans, and see if our mummy brethren can benefit from this information.

Benefits of Water

Every system in our body uses water.  Without water many essential processes slow down or do not function optimally.  Some of the most important functions of water in the body:

  • carrying nutrients to your cells
  • allowing your cells to remove debris
  • flushing bacteria out of the bladder
  • supporting digestion
  • regulating bowel movements
  • supporting blood pressure
  • protecting joints
  • regulating body temperature
  • maintaining salt balance in the body

Signs of Dehydration

Dehydration can occur quickly, especially on hot days, or slowly with compounded effects day after day.  If you have any of the following signs of dehydration, you should increase your water intake and talk to your doctor.

  • headaches
  • dizziness
  • weakness
  • low blood pressure
  • confusion
  • dark coloured urine
  • dry skin
  • bandage wrapped skin and a birth date more than 100 years ago

How Much Water to Drink?

There is no hard rule for how much water to drink, but there are some general guidelines which can be helpful in keeping you hydrated.

  1. Two to three cups (250ml) per hour – This will keep you hydrated all day long
  2. 8×8 rule – eight 8oz glasses per day. – Simple, easy to remember, but not based on any hard science, the 8×8 rule is likely to work for most people
  3. 5-1.0 ounces per pound of body weight – A nice guideline that can be easily individualized based on your weight. Aim for the higher amount during hotter or drier weather.

For mummies, the recommended amount of water is likely to be much higher due to a baseline of severe dehydration.  I recommend tripling the above recommendations to meet a mummy’s water needs.

Human, or mummy, water is essential to our quality of life.  So pick a guideline above and challenge yourself to drink your way to optimal health.

Disclaimer

The advice provided in this article is for informational purposes by the supernatural community. It is meant to augment and not replace consultation with a licensed monster doctor. Consultation with a Naturopathic Doctor, Dr. Frankenstein, or other primary care provider is recommended for any supernatural being suffering from a health problem.

Laryngitis in Mermaids: Top Five Tips

There is no more famous case of laryngitis than that of the Little Mermaid. While her voice was lost due to an unfortunate deal with an evil sea witch, mermaids must be mindful of maintaining their voices lest they lose the ability to lure unsuspecting sailors to their destiny in the sea.

This article gives my top five tips for treating and preventing laryngitis in mermaids, mermen and sirens. Don’t let your lost voice be the loss of your allure.

  1. Increase Vitamin C

Vitamin C can help merfolk boost their immune system and overcome the inflammation of laryngitis. Sea vegetables, like dulse or kelp, contain about 20mg of vitamin C per tablespoon. So up your seaweed intake, or consider getting a vitamin C supplement – it is a water soluble supplement so watch that it doesn’t dissolve in the sea.

  1. Sage Tea

Sage (Salvia officinalis) is a land plant that is most often associated with Thanksgiving turkey dinners. However, it can be used by humans and mermaids alike to calm a sore throat and heal laryngitis. Sage has astringent, antiseptic and antibacterial properties that make it ideal for laryngitis.

Sage is most commonly used as a tea – brew 1-2 tsp in boiling water and drink warm (2-3 cups per day). You can also add honey if available in your neck of the sea. Don’t use sage if you are breastfeeding merbabies, as it can reduce milk supply.

  1. Licorice Reduction

Licorice (Glycyrrhiza glabra) is the root from another land plant and has anti-inflammatory and soothing properties. My favourite way of using licorice is as a reduction. Simple to prepare, and delicious, licorice reduction is safe for meradults and merchildren.

To make the reduction boil 8 tbsp of licorice root in 6 cups of water. Reduce heat and simmer until the mixture reduces to 1 ½ cups. Remove from heat and add 6 tbsp of honey. Cool, bottle and keep in a cool wet sack. Merchildren can have 1 tsp three times per day, and meradults can have 1 tbsp three times daily.

  1. Total Voice Rest

While the temptation for mermaids may be to sing, total voice rest is recommended for any merfolk suffering with laryngitis. Even whispering can prolong the inflammation in the laryngx and slow healing. So give your voice a rest for a few days and trust to your body language to get your message across.

  1. Don’t Trust Sea Witches

My final suggestion for preventing laryngitis is to avoid sea witches, and never trust one if you do encounter one. Sea witches are one of the most common causes of laryngitis in mermaids (although a rare cause in humans). Remember – an ounce of prevention is worth a pound of cure – so leave the sea witches to their own devices and reduce your risk of developing laryngitis.

Disclaimer

The advice provided in this article is for informational purposes by the supernatural community. It is meant to augment and not replace consultation with a licensed monster doctor. Consultation with a Naturopathic Doctor, Dr. Frankenstein, or other primary care provider is recommended for any supernatural being suffering from a health problem.

 

Vampires and Vitamin D Deficiency

Very little is known about the health issues impacting our supernatural community. Notoriously secretive, no agency (that we are aware of) is maintaining statistics on the health of supernatural beings. In this series I will be bringing a greater awareness to this issue, discussing some of the most common concerns impacting the magical members of our global community. Perhaps through education we may bring some light to those inhabiting our darkest nights.

No Sunshine in Their Lives

The existence of vampires has been documented in cultures around the world since ancient times. While exact population counts are impossible to attain, vampires are thought to be one of the most populous of all the supernatural beings.

Dwelling only in the darkness, vampires at are significant risk of vitamin D deficiency. Vitamin D is produced when the sun’s ultraviolet rays (UVB rays) penetrate the skin. With full body exposure to sunlight, a body can produce upwards of 10 000 to 20 000IU of vitamin D after just 15 minutes. This duration of sun exposure would certainly be fatal to a vampire.

40% of Humans, 100% of Vampires

It is estimated that 40% of humans are deficient in vitamin D, with rates being much higher during the winter months when UVB rays are unable to the Northern hemisphere. With no exposure to the sun it may be estimated that 100% of vampires are likely to be deficient in vitamin D.

Risks of Vitamin D Deficiency

Vitamin D deficiency can lead to an increased incidence of colds and influenza, osteoporosis, autoimmune disease, and over 16 different types of cancer, including breast, pancreatic and lung cancer.

Vitamin D Supplementation for Vampires

Ideally testing for vitamin D levels should be carried out on vampires to determine ideal dosing. As vampires are notoriously secretive, and very few laboratories are open after dark, testing may be difficult to attain. I suggest all vampires consider a vitamin D supplement, to ensure their needs are met. A general guideline for humans and vampires is to take a minimum of 1000IU per day. Your Naturopathic Doctor can help to individualize your dose based on your body weight and sun exposure (or lack thereof).

Disclaimer

The advice provided in this article is for informational purposes by the supernatural community. It is meant to augment and not replace consultation with a licensed monster doctor. Consultation with a Naturopathic Doctor, Dr. Frankenstein, or other primary care provider is recommended for any supernatural being suffering from a health problem.

The PMS Diet

Premenstrual syndrome may hit you like a storm each month, throwing your mood and your body into chaos and misery. But does it have to be like that? We all know women who sail through their cycles with not a concern in the world. Is it possible that we all can achieve that level of hormone harmony and banish our PMS symptoms? Yes, I believe it is.

The PMS Diet

My philosophy is that health comes from the balance of three key components:

  1. What we put into our bodies (food, alcohol, drugs, etc.)
  2. How we move our body (exercise, flexibility, play, etc.)
  3. The thoughts we hold in our mind-body (gratitude, self love, frustration, etc.)

With this philosophy at the core of my approach, I often suggest that women with hormone imbalances consider the impact of their diet. And in PMS your diet can have a huge impact – for good, or for bad. So lets get to it and discuss how you can have an impact on your PMS by optimizing your diet.

  1. Quit sugar

Ladies, you know this one. But it is so damn hard to do – your body can send some pretty strong cravings for sugar when hormone imbalances associated with PMS cause your serotonin to plummet. But sugar is not going to make anything better.

Women who experience PMS eat, on average, 275% more refined sugar than women who do not have PMS. What?!! That’s a ton of sugar! And women with PMS also consume between 200-500 more calories per day – typically in the forms of carbohydrates, fats and sweets. That is not going to make anyone feel better!

The main issue is that sugar increases the loss of magnesium in the urine – and magnesium deficiency is thought to be the cause of a lot of PMS symptoms, including fatigue, irritability, brain fog, insomnia as well as period cramps. Just to add to your misery, sugar also increases salt and water retention, leading to swelling and breast tenderness. Ugh.

  1. Avoid alcohol

We’re still in common sense country here, but avoiding alcohol really is something you need to do if you want to balance your hormones and eliminate PMS. While reaching for a glass of wine (or two) is tempting when you’re in a PMS rage, you are not making things any better. Alcohol can inhibit your liver’s ability to detoxify hormones, and can lead to higher circulating estrogen levels. This can exacerbate the imbalance of hormones that is already thought to cause PMS – high estrogen to low progesterone.  So consider making a cup of tea instead, and skip the alcohol for your own sake.

  1. Cut the caffeine

I’m really not making any friends with this article. I’m feeling like a bit of a buzz kill! But let’s talk straight – hormone imbalances are strongly associated with our behaviours. And we can change our behaviours!

Drinking coffee, and other caffeine-containing beverages, has been found to be associated with PMS, and with a greater severity of PMS. If you have PMS, I encourage you to try a cycle without caffeine and see if you notice an improvement, a lot of the women in my practice have found this to have a huge impact.

  1. Skip the salt

If you experience bloating, breast tenderness or swelling during PMS, you should check your diet to see if you are eating too much salt. Mostly found in processed food, salt can contribute to water retention, and swelling. Skipping prepared, processed and fast foods should bring your salt intake down to a balanced and healthy level.

  1. Get complex

Breads, bagels, crackers, pasta and other simple carbohydrates are setting you up for blood sugar instability and almost guaranteeing a miserable PMS. Instead of these foods, opt for the complex carbohydrates, these are slower to digest, keep you full longer and your blood sugar stable. Women who eat more complex carbohydrates also eat more fiber, an important nutrient that promotes estrogen elimination from the body.

So banish the bread and instead go for whole grains – brown rice, oats, quinoa, millet, and amaranth are delicious. And try sweet potatoes, squash, lentils, and beans for filling complex carbohydrates.

  1. Go green

Leafy greens are a PMS fighting superfood! A rich source of calcium and magnesium, leafy greens also support liver function, encouraging the liver to detoxify and eliminate excess estrogen. Choose your favourite leafy greens and eat them every day – kale, spinach, arugula, swiss chard or collard greens are all excellent choices!

  1. Go fish!

Fish, and other foods that are rich in vitamin B6, are important for any woman struggling with PMS. B6, a water-soluble nutrient, is involved in over 100 reactions in our body, many of which are involved in the production of hormones and neurotransmitters. Vitamin B6 is one of the best studied nutrients for PMS, and it has been found to help restore balance for women with PMS and reduce symptoms, especially mood symptoms such as irritation, anger and sadness.

  1. Open sesame

Sesame seeds are an excellent source of calcium, and clinical trials have found that women with the highest intake of calcium have the lowest incidence of PMS symptoms. While most studies have been on calcium supplements, increasing dietary calcium is a great place to start.

Other great sources of calcium include tofu, sardines, leafy greens, cabbage, broccoli, green beans, squash, bean sprouts, almonds, brazil nuts, quinoa, chickpeas, beans and oranges.

  1. Beans, beans, beans!

There are many reasons why beans pack a powerful punch in treating PMS. Beans are an excellent source of magnesium, one of the most important nutrient imbalances in PMS. Taken as a supplement, magnesium can improve mood, reduce breast tenderness and relieve pain during periods.

But beans offer more than just magnesium. They also are a rich source of fiber and protein. Women who consume a mostly vegetarian diet have lower incidence of PMS and lower levels of estrogen – both benefits that can be achieved by just increasing the beans in your diet.

  1. Boost Bacteria

Fermented foods, like kim chi, sauerkraut, kombucha and kefir all contain probiotics – healthy bacteria that can live in our digestive tracts and support our overall health. Healthy bacteria do more than just help our digestion, they also support hormone balance – especially estrogen elimination, an important component of managing PMS.

When your bacteria balance is optimal your body is able to easily eliminate estrogen. When your bacteria levels are out of balance estrogen levels increase and can significantly contribute to PMS. So try some fermented foods, or take a daily probiotic to balance your bacteria.

 Diet and More

Diet is an excellent place to start in treating your PMS.  It may seem simple, but simple things can sometimes be incredibly powerful.  Each action you take on a daily basis, each food you eat, or those foods you don’t eat, all influence your hormone balance and determine whether you sail through PMS or struggle.  Once you have started with these dietary changes, if you are still experiencing symptoms, check out my top treatments for PMS, ask whether you may be experiencing PMDD or take a refresher on the hormonal imbalances of PMS.  And if you are ready to take the next step, feel free to get in touch so we can work together on resolving your PMS.

Disclaimer

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

 

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PMS or PMDD?

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

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

A Diagnosis of PMDD

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

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

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

Treatment of PMDD

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

Natural Approaches to PMDD

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

Vitamin B6

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

Calcium

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

L-tryptophan and 5-HTP

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

St. John’s Wort

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

Chaste Berry

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

IV Micronutrient Therapy

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

Bio-Identical Progesterone

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

Empowering Your Journey

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

Select Resources

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

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

Disclaimer

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

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