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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.

 

 

 

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.

 

Hormones in Weight Loss

We believe we can get healthy by losing weight – but we need to be healthy to lose weight

Weight loss is a lot more than just watching what you eat and how much you exercise.  While diet and exercise are essential components of a weight loss program, if your hormones are not in balance you will always be fighting against your body to lose fat and improve your body composition and health.

In this article I discuss some of the most important hormones for weight loss – our hormone helpers, and our hormone haters.  For a more in depth look at your personal hormone balance, consider booking an appointment with a naturopathic doctor for individual testing and hormone assessment.

Weight Loss: Hormone Helpers

Thyroid Hormone

Thyroid hormones are our metabolism masters – they control the rate of energy production (metabolism) throughout the body. When thyroid hormones are too low symptoms of fatigue and weight gain can occur. When thyroid hormones are too high symptoms of anxiety, jitteriness and weight loss are common.

The optimal range for TSH (a measure of thyroid function) for weight loss is 0.75-2.5.  Outside of this range can alter metabolism and make weight loss difficult.

Glucagon

Glucagon hormone works with insulin to balance blood sugar – insulin rises when blood sugar is high, glucagon rises when blood sugar is low. Improving glucagon levels helps us to keep our blood sugar stable and support weight loss.

Not surprisingly, activities that support stable blood sugar can improve glucagon levels. Specifically exercise and healthy protein consumption can increase glucagon levels while a diet high in sugar decreases glucagon.

Growth Hormone

Growth hormone is produced throughout our lifetime although it’s production is highest during our younger years. Growth hormone is necessary for tissue repair, muscle building and improving the density of bone.

The majority of growth hormone is produced overnight but it is also produced during exercise. Low levels of growth hormone (associated with poor sleep, eating too close to bed and lack of exercise) can lead to fatigue, depression, cholesterol imbalances, and abdominal weight gain.

Leptin

One of our weight-loss helpers, leptin is our appetite-suppressing, full-sensation hormone. It is released by fat cells and communicates with our brain that we have had enough to eat.

We can improve our leptin levels through our lifestyle. Sleep, regular exercise, sufficient calories from our food and weight loss all help to balance leptin and improve our body composition.

We can also sabotage our leptin balance through our lifestyle choices. A regular intake of excess saturated fat and sugar leads to “leptin resistance”. When this occurs the brain no longer respond to high circulating levels of leptin and allows you to keep eating despite not being hungry.

Weight Loss: Hormone Haters

Ghrelin

Ghrelin works very closely with leptin to maintain our body weight. Ghrelin is the hunger hormone, produced when your digestive tract is empty. If you stomach is growling, ghrelin is being produced.

Ghrelin tells our brain when we’re hungry, and leptin tells us when we’re full.

Cortisol

Cortisol is most commonly known as our “stress hormone”. It is produced in high levels during stress, but our bodies produce varying levels over the course of every day.

High levels of cortisol can influence our eating habits and our hormone balance. People with elevated cortisol often crave sugary and salty foods, leading to an increase in insulin levels and all the symptoms associated with that imbalance.

Cortisol also stimulates a process in the liver known as “gluconeogenesis” – our body makes sugar to provide us fuel to get away from our stress. If we don’t use this extra sugar (by exercising) it gets deposited as fat around our midsection.

Insulin

Insulin helps our cells get energy in the form of sugar. When we eat foods that contain sugar (fruits, vegetables, grains, processed foods) our body releases insulin as a way of controlling blood sugar levels – getting the sugar out of the blood stream and into our cells.

When insulin levels are too high our cells can become less sensitive to it’s effects – leading to ‘insulin resistance’. This then leads to cravings for more sugar to meet the needs of our cells. And more insulin is released, and a vicious cycle ensues.

High levels of circulating insulin are associated with weight gain (especially around the belly). When you have excess insulin you can not burn fat as energy – your body will just demand more sugar to bring the insulin levels down. This makes losing abdominal fat almost impossible.

Serotonin

Serotonin is one of our feel-good neurotransmitters (along with dopamine and norepinephrine). When serotonin is out of balance symptoms of anxiety and depression are common. These emotions contribute negatively to weight loss by altering our motivation, drive, commitment and self esteem.

The depression associated with low serotonin leads to increases in inflammation and cortisol levels – both of which make it harder for our body to burn fat as fuel and lose weight.

Low levels of serotonin also decrease mood and lead us to crave foods that are rich in carbohydrates – a source of tryptophan, which our body uses to create serotonin.

Estrogen

Estrogen is the most common female hormone (although men have it too!) It is produced mainly in the ovaries but fat cells also produce large quantities of estrogen. High levels of estrogen, or “estrogen dominance” is as great a risk factor for obesity as having a poor diet or not exercising.

Estrogen balance is greatly impacted by our lifestyle and environment. Exposure to chemical estrogen-mimicking compounds, alcohol consumption, a high fat diet, lack of exercise and sleep deprivation can all lead to abnormally high levels of estrogen.

Hormones are incredibly important for our overall health, energy and metabolism.  If you are struggling to lose weight, or are stuck at a weight loss plateau, perhaps hormones are your issue.  Book a free 15 minute consultation now to discuss your options, and get your hormones back in balance.   

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.

Hormone Harmony in PMS

Welcome to the first installment of the “Hormone Harmony” series. In this series I’ll be exploring some of the most common states of female hormone imbalance, how your hormones can explain your symptoms, and some simple hormone hacks to help bring your body back into a state of hormone harmony.

Premenstrual Syndrome (PMS)

While a definition of PMS may not be necessary if you are reading this (it’s likely you’ve had first hand experience), I will try to give one that encompasses exactly what PMS is.

PMS is a recurrent set of physical and/or behavioural symptoms that occurs 7-14 days before a period and negatively impacts some aspect of a woman’s life

There have been over 150 (seriously!) symptoms of PMS identified. Some of the most common include:

  • Low energy
  • Mood changes – anger, crying, irritability, anxiety, depression, bitchiness
  • Food cravings
  • Headache
  • Low sex drive
  • Breast tenderness
  • Digestive upset – constipation, bloating, diarrhea, gas
  • Difficulty sleeping

Unfortunately we don’t really know what causes some women to experience PMS more than other women. But hormone imbalances are a common proposed cause, and in my practice I see balancing hormones as the most important means of decreasing symptoms of PMS.

Hormone Imbalances in PMS

The relationship between estrogen and progesterone is one of the most important hormone balances in a woman’s body. Imbalance in estrogen and progesterone levels is thought to be the primary cause of PMS.

Estrogen is produced throughout the month by the ovaries, adrenal glands and fat cells. It main action is growth – growth of breast tissue in puberty, and growth of the endometrial lining in the uterus during menstrual cycles.

Progesterone is produced during the second half of the menstrual cycle – after ovulation – by the ovaries.  Progesterone helps to balance the effects of estrogen and prepare the uterus for a possible pregnancy.

A too high estrogen level, or a too low progesterone level is thought to be the most likely cause of PMS symptoms in most women. This state, commonly called “estrogen dominance” is the most common hormone imbalance in women between the ages of 15 and 50. Estrogen dominance is becoming more common in North America due to increasing exposure to xenoestrogens (chemicals in our environment that mimic estrogen), high rates of obesity, decreased ability of our livers to detoxify and overwhelming amounts of stress.

The important thing to remember with PMS and hormone balance is that it is the relationship and balance of estrogen and progesterone that leads to symptoms. You may have normal levels of estrogen, but if your progesterone is low you will still experience symptoms. Progesterone levels are low in women who do not ovulate, and in those with significant stress (your body will convert progesterone into cortisol, leaving you deficient in much-needed progesterone).

Hormone Hacks for PMS

If you are a woman experiencing PMS, taking charge of your hormones and getting them into balance can make a huge difference in your quality of life. Below are some simple Hormone Hacks to get you started.

  1. Follow the PMS diet

There have been some significant findings in the diets of women who suffer from significant PMS. Compared to women who do not have PMS they eat 275% more sugar, 79% more dairy and 62% more refined carbohydrates. Avoiding these foods – and instead choosing fruits, vegetables, whole grains and healthy proteins – can diminish PMS symptoms significantly and promote healthy hormone balance.

  1. Cut the caffeine

No one wants to hear it, but drinking caffeine-containing beverages increases the severity of PMS. And those effects are worsened if you add sugar to your tea or coffee. So cut back, or cut it out all together if you want to decrease your PMS.

  1. Exercise

Women who exercise regularly have less PMS. Multiple studies have found this to be true, and the more frequently you exercise the better the boost. Exercise is known to decrease estrogen levels – so get out there and get moving.

  1. Get your nutrients in

Deficiencies in many nutrients have been found in women with PMS. Some notable ones include magnesium, vitamin B6, and zinc. All of these nutrients can be found in nuts and seeds – also known to be excellent sources of vegan protein.

  1. Get tested

Understanding your hormone imbalances can be incredibly valuable to managing symptoms like PMS. Testing your hormone levels will give you a clear understanding of what is happening in your body during a specific phase of your menstrual period. For PMS we test hormone levels (estrogen, progesterone and prolactin) about 7 days before your expected period.

  1. Herbal hormone balancers

There are some phenomenal hormone balancers in the world of herbal medicine. Vitex agnus-castus (also known as chaste berry) can improve progesterone levels, helping to balance estrogen dominance. Phytoestrogens, like those found in black cohosh, soy and flaxseeds, can also help to normalize estrogen levels by decreasing the action of our body’s own estrogen in favour of the milder estrogen signal from plant estrogens.

  1. Bioidentical progesterone

When all else fails in hormone balancing for PMS, your naturopathic doctor can prescribe low dose bioidentical progesterone in a cream that you can apply during the final weeks of your menstrual cycle. This will be helpful if your progesterone levels are low, or if your estrogen levels are high. Be sure your ND is qualified to prescribe bioidentical hormones, as additional training is required.

Don’t suffer with hormone imbalances like PMS.  You can achieve hormone harmony, and working with a Naturopathic Doctor can get you there.  Book an appointment, or a meet and greet now to find your personal balance.

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.           

Acupuncture for IVF and IUI Cycles

The use of acupuncture as a supportive treatment for couples undergoing assisted reproductive therapies, including in vitro fertilization (IVF) and intrauterine insemination (IUI) is gaining in popularity, likely due to promising results in countless studies in the past 20 years.

Understanding how acupuncture can improve outcomes in IVF and IUI cycles can help you to decide if this treatment may be right for you.

A brief understanding of IVF and IUI

In vitro fertilization, or IVF is the process where a woman’s follicles are stimulated through medications to mature many follicles simultaneously. Once the majority of follicles are mature (17-20mm) they are retrieved and fertilized in a lab. These embryos grow for 3-5 days and are then transferred into the woman’s uterus (usually 1-2 at a time).

Intrauterine insemination will often also use medications to stimulate follicle growth, but the number of follicles is far fewer. The follicles develop within the woman’s ovaries and at ovulation the semen is inserted directly into the uterus and fertilization occurs within the body.

The success rates of IVF and IUI are variable. IVF alone is around 25-30% and IUI alone is around 13-20%. With acupuncture support, success rates can increase up to 40-60%.

How acupuncture benefits IVF and IUI cycles

Acupuncture has many benefits for improving outcomes (pregnancy rates and delivery rates) in IVF and IUI cycles. A 2002 study by Paulus and colleagues in Germany was one of the first to demonstrate an improvement in pregnancy rates with acupuncture in IVF cycles. The women receiving acupuncture had a 42.5% success rate, compared to 26.3% for those who did not receive acupuncture. Many more studies have since confirmed these findings, with impressive improvements in pregnancy and delivery rates.

Acupuncture is a very safe therapy, with relatively low costs and has no negative interactions with medications. Below I highlight some of the benefits acupuncture has on IVF and IUI cycles.

  1. Improved ovarian response

Acupuncture is based on traditional Eastern philosophies of meridians and acupuncture points. However, we now know that significant hormonal changes occur when we administer acupuncture to specific points in the body. Acupuncture impacts beta-endorphin levels, which in turn impact our production of reproductive hormones (notably GnRH, FSH, LH, estrogen and progesterone). Acupuncture can thus improve response of the ovaries to these hormones and optimize follicle development.

  1. Improved hormone balance

As mentioned above, acupuncture has a significant impact on hormone production and response. In IVF cycles where hormone-modulating medications are used, acupuncture can help the body to respond appropriately to medications, and minimize side effects.

  1. Improved egg (follicle) quality and quantity

Clinically acupuncture has been shown to positively influence the number and integrity of eggs released during IVF and IUI cycles – this may be due to increasing the blood supply to the developing follicles or by increasing the nutritional supply to the egg via the fluids that surround and nourish it.

  1. Improved blood flow to the uterus and increased rate of implantation

One of the most unique actions of acupuncture, increasing blood flow to the uterus can improve implantation rates and decrease rates of miscarriage. No medication currently exists that can enhance blood flow to the uterus the way acupuncture has been demonstrated to.

  1. Optimal endometrial thickness

In women with thin endometrial linings IVF can have higher rates of failure. Acupuncture can help to thicken the endometrial lining (through the enhancement of blood flow) and improve rates of implantation.

  1. Decrease rates of miscarriage

Acupuncture used during IVF results in higher rates of viable pregnancy. Additionally, acupuncture was found in a 2004 study by the American Society for Reproductive Medicine to lower miscarriage, reduce tubal pregnancy and increase live birth rate.

  1. Reduce stress

Stress is a major factor impacting most couples undergoing fertility treatments. Acupuncture treatments have been shown to decrease sympathetic nervous system activity (our fight-or-flight response), decrease stress hormone levels and increase opioid production – all resulting in a sense of calm and decreased stress.

Acupuncture treatments for IUI and IVF

Acupuncture treatments should be individualized to your IVF or IUI cycle, your personal medical history and current health state. For women undergoing IVF or IUI it is recommended in clinical studies to start having acupuncture 8-12 weeks (2-3 months) prior to your IUI or IVF procedure.

In my Toronto practices, I use acupuncture points selected based on clinically proven protocols (Paulus protocol, Stener-Victorin protocol, Westergaard protocol, Smith protocol), as well as points based on Traditional Chinese Medicine diagnoses and indications.

Success in acupuncture depends on more than just the frequency and timing of visits. It also requires a knowledgeable practitioner who can guide you through the process and help you achieve the benefits you desire. If you’d like to learn more, book a free meet and greet consultation or initial intake today.

References

Betts D. The Essential Guide to Acupuncture in Pregnancy and Childbirth. 2006.

Change, R, Chung P, Rosenwaks Z. Role of acupuncture in the treatment of female infertility. Fertil Steril. 2002 Dec:78(6)

Dieterle, S., et al. Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study. Fertil Steril. 2006 May;85(5):1347- 51.

Gurfinkel E, et al. “Effects of acupuncture and moxa treatment in patients with semen abnormalities.” Asian J Androl. 2003 Dec;5(4):345-8.

Johnson D. “Acupuncture prior to and at embryo transfer in an assisted conception unit – a case series.” Acupunct Med. 2006:24(1):23-28.

Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil Steril 2002;77(4):721-4.

Stener-Victorin E, et al. “Use of acupuncture in female infertility and a summary of recent acupuncture studies related to embryo transfer. Acupunct Med. 2006 Dec;24(4):157-63. Review.

Westergaard. LG, et al. “Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial.” Fertil Steril. 2006 May;85(5):1341-6.

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.

 

 

 

Female Hair Loss: Lab Testing

My expertise in treating hair loss in women started with a personal experience of hair loss in my 20s. After being dismissed by my Medical Doctor who assured me it was “totally normal” I persisted in understanding why a healthy woman in her 20s would start losing hair.

Laboratory Testing for Female Hair Loss

As I discuss in my article, Getting to the Root of Female Hair Loss, treating hair loss can only be effective if you understand the root cause – why is a woman losing hair? Through laboratory testing an answer can often be found.

When I am working with women with hair loss I generally advocate for a tiered approach to lab testing for hair loss – starting with the most likely causes and progressing to the more complex.

For myself, the issue was an iron deficiency. By correcting that iron deficiency I was able to resolve my hair loss in under a year and it hasn’t recurred since.

Use the checklist below with your Medical Doctor or Naturopathic Doctor to determine the root cause of your hair loss. And if you’re ready to work with someone experienced in hair loss in women, get in touch and book an appointment today.

Female Hair Loss – Printable PDF

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.

 

Love and Happiness: Hormone Hacks for a Happy Life

Hormones are chemical messengers that influence essential aspects of our health and wellbeing. The emotions of love and happiness are included as essential components of our lives. Three key compounds are involved in love and happiness – oxytocin, dopamine and serotonin. Today I’ll discuss the action of each and give some Hormone Hacks to help you boost your love and happiness in your day-to-day life.

Oxytocin

Oxytocin is a hormone and neurotransmitter that is often called the love hormone or the cuddle hormone. It is produced during times of bonding – during labour, breastfeeding and intimate contact with loved ones.

The release of oxytocin increases empathy and sensitivity to the emotions of others. It increases trust, caring for others and positive social interactions. It can make you feel more extroverted, and may even encourage you to lie for the benefit of a group!

Oxytocin also influences other hormones, leading to decreased stress hormone production and strong anti-anxiety effects.

Levels of oxytocin are high during the first six months of a romantic or significant relationship, but we can carry on that oxytocin high by focusing on these Hormone Hacks.

Touch and warmth – massage has been found to increase oxytocin, as has cuddling, holding hands, kissing or petting an animal

Give and receive hugs – some experts suggest both your immune system and oxytocin levels will benefit from 12 hugs per day

Eye contact – positive eye contact can increase oxytocin significantly, especially during intimate conversations and physical contact

Positive smells – smells associated with positive memories can increase oxytocin

Practice gratitude – focusing on the blessings in our lives can improve our mood, well being, and oxytocin levels. Simple steps like keeping a gratitude journal or sharing gratitude at the dinner table can go a long way towards improving happiness

Participate in something great – volunteer work, social movements, and any activity that benefits society and the greater good can boost oxytocin and social connectivity

Orgasm – the most direct line to increased oxytocin, it is produced by both men and women at orgasm. The boost is especially pronounced in loving relationships

Interesting fact: oxytocin is being studied for its potential benefits for autism and increasing empathy and social interaction. It may also be useful for tinnitus, but only preliminary studies have been done.

Dopamine

Dopamine is a feel-good neurotransmitter and hormone that is produced during new and novel experiences. It is a reward based neurotransmitter that increases desire, focus and attention, short term memory, boldness and delight in small details. It can also lead to a lower need for food or sleep and increase risk taking.

It is also a hormone associated with addiction. Dopamine feels good, so we repeat behaviours that encourage dopamine production, even if they have damaging effects on our lives.

Knowing this aspect of dopamine we can focus on building habits that are positive to our overall wellbeing.

Below are some Hormone Hacks to increase the beneficial effects of dopamine.

Try something new – engaging in a new activity will boost dopamine. Traveling to new places, visiting art galleries and trying new and novel activities

Eat something spicy – eating seemingly dangerous foods – spicy, hot, icy, fermented – will all trick your body into a dopamine boost

Take a healthy risk – riding rollercoasters, watching scary movies or playing video games, basically any mildly thrilling activity will increase dopamine

Achieve a goal – even small goals like finishing a book, finishing a chore, winning a game against friends can give you a dopamine edge

Meditation and visualizationmeditation has been found in studies to increase dopamine. And if you aren’t feeling adventurous enough for a rollercoaster, just visualizing the activity can trigger a dopamine release – just as if you were actually doing it!

Serotonin

Another feel-good neurotransmitter, serotonin is essential to a balanced, happy mood. It is also necessary for will power, to create long term plans and delay gratification. Serotonin makes us feel like anything is possible.

Serotonin is made both in the brain and in the digestive tract (80-90%). Not only does serotonin impact mood and memory, but also appetite (especially carbohydrate cravings), nausea and bowel function.

Low levels of serotonin are found in impulsivity and depression – but we don’t know if the low serotonin is a cause or effect of depression.

Increasing serotonin is often done through medications (some legal, others not), but there are many natural ways to increase serotonin.

Sunshine – outdoor light, or light boxes (available at some Toronto area libraries, or for personal home use) stimulate serotonin production and vitamin D synthesis, an essential nutrient for serotonin action

Exercise – in addition to making us feel good, exercise improves the function of serotonin in the brain

Massage – another kudos to massage therapy – massage can increase serotonin levels by 28% and decrease the stress hormone cortisol by up to 30%

Eat your greens – vitamin B6 (pyridoxine), found in leafy greens, cauliflower, fish and lean poultry, is an essential nutrient for the production of serotonin. Low levels can lead to low serotonin

Eat legumes – legumes, particularly chickpeas, are high in tryptophan – the amino acid necessary for serotonin production. Other foods high in tryptophan include nuts, seeds, tofu, turkey, lentils, eggs and dairy

Remember happy events – surrounding yourself with positive memories – photos and mementos of happy moments, special occasions, and loved ones, can give you a serotonin surge every time you see them and remember happy times

Hormones really are essential components to our health and happiness. Use these Hormone Hacks to help increase the love and happiness in your life. Got a tip I didn’t include? Please leave it in the comments below.

And if you’re interested in achieving your personal Hormone Harmony, book an appointment now.

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.