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Six Natural Treatments for Menopause

Menopause is the natural transition out of the childbearing years of a woman’s life.  So why is this natural transition often treated with synthetic hormones that have increase your risk for stroke, pulmonary embolism, coronary artery disease and breast cancer?

Symptoms of menopause begin for most women between 46-55 years of age and can persist for 2-20 years (8 years is average).  With the risks associated with synthetic hormone replacement therapy (HRT) more and more women are looking for natural alternatives.  Learn more about six of the top recommended natural treatments for menopause and how they may help you transition smoothly through menopause.

Black cohosh (Actaea racemosa)

Black cohosh (Actaea racemosa)

Black cohosh is one of the most important and popular natural remedies for menopause.  Several large studies have found that daily use of black cohosh for a minimum of 8 weeks improved symptoms of menopause including hot flashes, night sweats, headaches, insomnia, mood swings, irritability and vaginal dryness.

Black cohosh is often self-prescribed but should be used under supervision of a Naturopathic Doctor.  Studies suggest that the effectiveness of black cohosh can be increased by combining it with other natural treatments.

Isoflavones

Isoflavones are compounds found in plants that have estrogen-like actions in humans.  They are also known as “phytoestrogens”.  Clinical studies have shown that isoflavones can reduce symptoms of hot flashes and vaginal dryness in menopause.

Additionally some isoflavones (particularly those in soy) are also effective preventative agents for certain types of cancer, including breast cancer.  Isoflavones also protect the body against heart disease, increase good (HDL) cholesterol, decrease bad (LDL) cholesterol and triglycerides, and help prevent osteoporosis.

Isoflavones are most commonly found in combination with other phytoestrogens.  A diet high in soy may also provide a significant amount of isoflavones, especially if fermented soy products like natto or miso are consumed.  Do not take soy based isoflavones, or consume a high soy diet if you have a history of thyroid disease.

Red Clover (Trifolium pratense)

Red clover (Trifolium pratense)

Red clover is a popular phytoestrogen supplement for management of menopausal symptoms.  It is most effective for hot flashes and night sweats.  It contains isoflavones so also has many of the same benefits listed above (decreasing bad cholesterol, prevention of osteoporosis).

There are multiple drug-herb interactions for red clover, so it should only be taken under supervision by a Naturopathic Doctor.  Red clover interacts with blood thinners and antivirals and may not be appropriate if you are taking these medications.

Vitamin C

Vitamin C and citrus bioflavonoids are known to improve the integrity of blood vessels and promote healthy blood flow.  This has been shown in preliminary studies to improve symptoms of hot flashes.  Vitamin C is also incredibly safe and can be taken in food form.  Good sources of vitamin C include citrus fruits, papaya, bell pepper, strawberries, cauliflower and dark green leafy vegetables.

Exercise

Exercise should be incorporated into a healthy lifestyle during the menopausal transition and beyond.  A list of some of the benefits of exercise in menopause are listed below.  Exercise has been demonstrated in clinical studies to improve quality of life in menopausal symptoms, and decreases the frequency and severity of hot flashes.  A combination of weight bearing and aerobic exercise at least 3.5 hours per week is recommended for women in menopause and postmenopausal women.

Health Benefits of Regular Exercise in Menopause           

  • Relief from hot flashes
  • Decreased bone loss
  • Improved cardiovascular function and circulation
  • Decreased blood pressure
  • Decreased cholesterol levels
  • Increased self-esteem, mood, endurance and energy levels

Acupuncture

The natural menopause treatment that has been getting the most media attention is acupuncture.  Acupuncture, when individually tailored to a woman’s menopausal symptoms can be extremely effective in decreasing discomfort and relieving symptoms.  A range of 6 to 12 sessions over an 8 to 12 week period should be used to determine if acupuncture will be effective.

As with all natural therapies, the most effective approach is an integrative one.  Consultation with a qualified Naturopathic Doctor who can tailor a treatment plan to your symptoms, current health and lifestyle will allow you to reap all the benefits natural therapies have to offer.

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.

References

Osmers R, Friede M, Liske E, et al: Efficacy and safety of isopropanolic black cohosh extract for climacteric symptoms.  Obstet Gynecol  2005; 105:1074-1083

Wuttke W, Seidlova-Wuttke D, Gorkow C: The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study: Effects on menopause symptoms and bone markers.  Maturitas  2003; 44 (Suppl 1):S67-S77.

Tice JA, et al: Phytoestrogen supplements for the treatment of hot flashes: The Isoflavone Clover Extract (ICE) Study: A randomized controlled trial.  JAMA  2003; 290:207-214.

Wyon Y, et al: A comparison of acupuncture and oral estradiol treatment of vasomotor symptoms in postmenopausal women.  Climacteric  2004; 7:153-164.

Lindh-Astrand L, Nedstrand E, Wyon Y, Hammar M: Vasomotor symptoms and quality of life in previously sedentary postmenopausal women randomised to physical activity or estrogen therapy.  Maturitas  2004; 48:97-105.

Nachtigall L, La Grega L, Lee W, Fenichel R. The effects of isoflavones derived from red clover on vasomotor symptoms and endometrial thickness. In: Proceedings of the 9th International Menopause Society World Congress on the Menopause. Yokohama, Japan: 1999.

Acupuncture for Infertility

Canadian infertility rates are twice what they were twenty years ago.  Up to 16% of heterosexual couples in Canada have difficulty conceiving and are looking for help.  As more heterosexual and homosexual couples and single women seek out ways to fulfill their desire to have children use of assisted reproductive technology (ART) has increased substantially.  With the rise of ART, we are also seeing a rise in men and women seeking out natural ways to enhance fertility or to improve the success rates of ART.  Acupuncture is the most popular natural fertility treatment either alone or in combination with ART.

Acupuncture and ART

The past 20 years have seen an explosion in the number of research studies demonstrating impressive results when combining acupuncture with ART.  A 2002 study performed by Paulus and colleagues in Germany rocked the reproductive world when it showed that women who received acupuncture with in-vitro fertilization (IVF) had a 42.5% success rate, compared to a 26.3% success rate for those who did not get acupuncture.  Considering the cost of IVF (both financial and emotional) this impressive result got the attention of both fertility specialists and people with infertility.

Many further studies have confirmed what Paulus reported in 2002.  In 2006 a study found that acupuncture during the second half of the menstrual cycle more than doubled pregnancy rates (33.6% vs 15.6%) for women undergoing IVF or ICSI (intracytoplasmic sperm injection – a type of IVF).  A second study in 2006 reported that acupuncture on the day of IVF embryo transfer (with acupuncture treatment administered both before and after the transfer) increased pregnancy rates from 26% to 39%.

These studies and many others like them demonstrate the profound impact acupuncture can have during assisted reproductive technology procedures.

Acupuncture and Female Infertility

Female factor infertility is implicated in half of all couples with difficulty conceiving.  There are many lifestyle, physical and hormonal issues that can lead to female fertility concerns.  Lack of ovulation, luteal phase defect, endometriosis, prolonged menstrual cycle, shortened menstrual cycle, polycystic ovarian syndrome, uterine fibroids, hypothyroidism, hyperthyroidism, recurrent miscarriage, pelvic inflammatory disease and unexplained fertility can all be addressed with acupuncture treatment.

How can acupuncture do all these diverse things?  Acupuncture works on multiple systems in our body with widespread and diverse effects.  Some of the ways acupuncture impacts fertility include:

  1. Regulate the hormone cycle: Acupuncture can regulate and support a balanced hormone cycle with a regular 27-30 day cycle, good quality fertile mucus, pain free ovulation, minimal premenstrual symptoms and a pain free period with appropriate bleeding (colour, quantity, no clots).
  2. Regulate ovulation: Acupuncture and Traditional Chinese Herbal therapies support ovulation occurring regularly on day 13 to 15 of a regular cycle, indicating that the egg is being released at its optimal developmental time.
  3. Increase blood flow to the uterus and ovaries: Acupuncture increases the blood flow to the ovaries and uterus, enhancing thickness and quality of the uterine lining, decreasing IVF failure and recurrent miscarriage. No medication currently exists that can increase blood flow to the uterus – acupuncture is the only intervention that has been shown to consistently have this effect.
  4. Enhance egg development: Clinically acupuncture has been shown to positively influence the integrity of eggs released – 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.
  5. Enhance the internal environment of the fallopian tubes: Acupuncture aims to improve the elasticity and the secretions of the fallopian tubes, facilitating the passage of the fertilized egg into the uterus.
  6. Promote embryo implantation: 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.
  7. Correct hormonal imbalances: Acupuncture can be used to influence hormonal secretion at the level of the pituitary, hypothalamus, thyroid, adrenals or ovaries.  Acupuncture can balance excess or deficient hormone levels and support a hormonal state that allows pregnancy to occur and proceed naturally.
  8. Decrease stress and enhance maternal health during fertility treatments and pregnancy: Stress is one of many factors that may negatively impact fertility.   Acupuncture treatments have been shown to decrease stress during fertility treatments and can support a balanced, healthy lifestyle for the mother.

Acupuncture and Male Infertility

Male factor infertility is also implicated in half of all infertile couples.  Male fertility requires three important features: adequate production of sperm in the testes, a clear path for sperm to travel through the seminal tract, and satisfactory delivery of the sperm to the waiting egg.  Low sperm count, poor sperm motility, poor sperm morphology (shape), anti-sperm antibodies, and low testosterone are all imbalances that may be addressed through acupuncture, usually in combination with nutritional and herbal supplements.

Acupuncture Treatments

Acupuncture treatments are tailored to your personal imbalance.  The timing and frequency of acupuncture sessions depends on your health and fertility concerns, your age, your menstrual cycle and your current state of balance/imbalance.  For women undergoing ART it is recommended in clinical studies that you begin having acupuncture a minimum of 8-12 weeks prior to IVF procedures.

Acupuncture points are selected based on clinically proven protocols (Paulus protocol, Stener-Victorin protocol), as well as points based on Traditional Chinese Medicine diagnoses and indications.  Your individual acupuncture point prescription may vary with your menstrual cycle, with different points being used based on the timing and length of your cycle.

For women undergoing IVF, your Naturopathic Doctor can accompany you on the day of embryo transfer to administer acupuncture before and after your procedure.  Discuss the option of on-site acupuncture with Dr. Watson in the weeks prior to your procedure.

Is Acupuncture Right for You?

The best way to determine if acupuncture is right for you is to have a consultation with a Naturopathic Doctor who is experienced in the treatment of fertility and proficient in acupuncture.  Dr. Lisa Watson offers free 15 minute consultations during which time you can ask questions regarding acupuncture and fertility and whether or not it would be recommended for you.

References

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

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.

Kirkey S.  Infertility rates rising for Canadian couples.  Postmedia news.  February 15, 2012.  Accessed online May 22, 2012.  Available online at: http://www.canada.com/health/Infertility+rates+rising+Canadian+couples/6157547/story.html

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.

Zhang, M, et al. “Influence of acupuncture on idiopathic male infertility in assisted reproductive technology.” J Huazhong Univ Sci Technolog Med Sci. 2002;22(3):228-30.

 

Treating Polycystic Ovarian Syndrome Naturally

Polycystic ovarian syndrome (PCOS) or “multiple ovarian cysts” affect many teenage girls and adult women.   PCOS often begins shortly after puberty and can persist for years.  It can be a frustrating, and sometimes painful condition.  It can also make becoming pregnant difficult.  However, there are natural treatment options available that are safe and effective even for teenaged girls.

What are ovarian cysts?

Ovarian cysts are formed when ovulation doesn’t occur as it is supposed to.  Within each ovary there are sacs called follicles that contain eggs.  Normally, one or more eggs are released during each menstrual cycle – this is ovulation.  In PCOS the eggs within the follicles do not mature and are not released from the ovaries.  Instead, they form small cysts in the ovary – ovarian cysts.

How do I know if I have PCOS?

Having ovarian cysts is not enough for a diagnosis of polycystic ovaries.  You also must have other symptoms of PCOS. Typically a combination of the following symptoms is present:

  • Ovarian cysts
  • No menstrual cycle, irregular or infrequent menstrual cycles
  • No ovulation
  • Infertility
  • Hair growth on the upper lip or chin
  • Hair loss from the head
  • Acne
  • Body fat around the waistline
  • Dark skin under the armpits, neck, groin or breasts

If you have symptoms of PCOS there are laboratory tests and ultrasound studies that should be done before a diagnosis of PCOS is made.

What causes PCOS?

PCOS is caused by hormonal imbalances.  An imbalance in a number of different hormones can lead to symptoms of polycystic ovarian syndrome.  Imbalances in the pituitary, ovaries, pancreatic and adrenal hormones have all been linked to PCOS.  Insulin resistance (a lack of responsiveness to insulin in the cells of your body) is an important factor in the development of PCOS.  Hormone testing should be done to identify your personal imbalances.

PCOS also has a genetic component – if a family member has it (your mother, aunt or grandmother) then you are more likely to develop it.

What treatments are available for PCOS?

With proper diagnosis and treatment, most PCOS symptoms can be effectively managed or eliminated.  The goals for PCOS treatment are to balance hormone levels, decrease insulin resistance and maintain a healthy body weight.

Most Medical Doctors will prescribe a daily birth control pill to manage PCOS.  This approach uses synthetic hormones to artificially ‘balance’ the body’s hormones.  Naturopathic Doctors use diet, vitamins, minerals, herbs and natural supplements to correct the body’s balance and teach it how to maintain balance without using drugs.

Diet and Lifestyle

Flax seeds are an excellent source of fiber and omega 3s

Because of the association between being overweight and having PCOS it is important to achieve and maintain a healthy body weight.  Losing as little as 5% of body weight can correct insulin resistance and decrease elevated hormone levels (specifically testosterone).

Select foods that are low on the glycemic index and high in fiber to decrease insulin resistance.  Daily exercise is also important for insulin resistance.  A daily fiber supplement can help some people meet their daily fiber goals.  Look for a fiber made from psyllium, guar gum or pectin.

Consider taking an omega 3 supplement (either fish oil or flax seed oil) and avoid consuming saturated fats.  For more information on omega 3 fatty acids read the article here.

Vitamins and minerals

Vitamin B6 can help balance prolactin levels, which are often elevated in PCOS.  B vitamins are also necessary for dopamine synthesis and adrenal hormone production.

Chromium is necessary for proper blood sugar regulation.  Taking chromium increases the uptake of glucose into cells, decreasing insulin resistance.

Herbs (Botanicals)

Vitex agnus castus

Saw palmetto (Serenoa repens) is a very effective hormone balancer for PCOS.  Saw palmetto decreases the conversion of testosterone to its more biologically active form (dihydroxytestosterone or DHT).  This results in lower levels of circulating testosterone.  Saw palmetto is effective in addressing symptoms of acne, hair loss, and facial hair growth.

Chasteberry (Vitex agnus-castus) is another herb used for PCOS.  Chasteberry inhibits prolactin synthesis and raises progesterone levels restoring balance to two important hormones involved in the menstrual cycle.  Low progesterone levels are very common during puberty and are known to contribute to the formation of ovarian cysts.

Natural supplements

Additional natural supplements may be prescribed by your Naturopathic Doctor to address your individual imbalances.  One natural supplement that is often used for PCOS is inositol (d-chiro-inositol).  A deficiency of inositol is often seen in women with PCOS.  Inositol has many benefits for PCOS – it decreases insulin and insulin resistance, decreases testosterone levels and can help promote regular ovulation.

Summary

Natural treatment of PCOS can take some time, and a focused effort.  A minimum of three menstrual cycles is usually needed to allow for the hormones to become balanced.  Your Naturopathic Doctor will provide you with support and can modify your treatment plan as needed based on your symptoms.  Remember to inform your Naturopathic Doctor if you begin taking any prescription or over-the-counter medications during your treatment because there can be significant interactions between natural supplements and drugs.

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 Essentials of Essential Fatty Acids

Essential fatty acids are just that – essential.  Our body can produce most of the fats it needs (such as cholesterol, saturated and unsaturated fatty acids), however it can not produce omega-3 or omega-6 fatty acids.  This makes them essential to consume in our diet.

Omega-6 fatty acids are found in the oils of seeds and grains, such as sunflower, safflower, soy and corn oils.   The average North American tends to consume adequate amounts of omega-6 fatty acids through their diet.

Omega-3 fatty acids are found in fish and fish oils, flax, walnuts and canola.  Omega-3 fatty acids have been shown in over 8000 studies to be important for human health and nutrition.  Omega-3s have a role in every stage of development from pregnancy and infancy through to elder adulthood.   The average North American diet does not provide adequate amounts of omega-3 fatty acids and most people would benefit from an omega-3 supplement.

The ABCs of EFAs

The language of essential fatty acids (also known as EFAs) can be confusing.  Knowing the basic ‘ABCs’ of the EFAs can simplify things and make selecting a supplement much easier.

ALA – alpha-linolenic acid.  An omega-3 fatty acid found in flax, walnuts and canola oil.  The other omega-3s (EPA and DHA) can be synthesized from this molecule.  The primary source of omega-3s for vegans.

DHA – docosahexaenoic acid.  An omega-3 fatty acid.  The richest source is fish and fish oil.  Especially important for the central nervous system, brain and eye.  Has anti-inflammatory effects in the body.

EPA – eicosapentaenoic acid.  An omega-3 fatty acid.  The richest source is fish and fish oil.  Important for mood and behaviour as well as anti-inflammatory effects.

GLA – gamma-linolenic acid.  An omega-6 fatty acid.  The richest sources are evening primrose oil, borage oil, and black currant oil.

LA – linoleic acid.  An omega-6 fatty acid.  Found in the oils of seeds and grains such as sunflower, safflower, soy and corn.   The other omega-6 fatty acids can be synthesized from this molecule.

Balancing 3s and 6s

In the body omega-3 and omega-6 fatty acids (ALA and LA) compete for the same enzymes to be converted into the health promoting long-chain omega 3s and 6s (DHA, EPA and GLA).  This is significant because the substances derived from the omega 3 fatty acids, EPA and DHA have opposite effects to the omega 6 derived substances.  EPA and DHA lead to eicosanoids that are anti-inflammatory, while the eicosanoids derived from GLA are pro-inflammatory.

High intake of dietary omega 6s can be detrimental to health by blocking enzyme conversion of the omega-3s to their active EPA and DHA form.  Maintaining an optimal ratio of omega-3s and omega-6s is essential for health.

The standard North American diet has a ratio of 20:1 omega-6s to omega-3s.  An ideal ratio is closer to 1:1 or 2:1.  Excess omega-6s have been implicated in thrombosis, vasoconstriction, inflammation, heart disease, autoimmune disease, rheumatoid arthritis, ulcerative colitis, multiple sclerosis, lupus, asthma, depression, and other chronic diseases.

Due to this imbalance in omega-3 and omega-6 fatty acids most people do not require an omega-6 supplement but could benefit from an omega-3 supplement to correct the essential fatty acid ratio.

The Benefits of Omega-3s

Higher intake of omega-3 fatty acids have numerous benefits and no disadvantages.  There are so many benefits of omega-3s that it is easiest to break down the benefits by system.   Unless otherwise indicated both EPA and DHA are recommended to achieve the listed benefit.

General Health

  • Improved mood and memory
  • Healthy metabolism
  • Bone strength
  • Healthy skin
  • Decreased inflammation
  • Better management of pain associated with arthritis, ankylosing spondylitis and back pain

Cardiovascular Health

  • Reduced triglycerides
  • Reduced blood pressure
  • Decrease inflammation in the heart and blood vessels
  • Decreased risk of angina, heart attack and stroke

Cognitive Health

DHA is important for development of the brain and nervous system in infants, and in the repair and protection of the nervous system from age-related damage.  DHA plays an important role in:

  • Development of fetal nervous system in utero
  • Improved cognitive function in infants, toddlers and children
  • Preventing dementia and Alzheimer’s in the elderly
  • Improving cognitive performance in the elderly

EPA (combined with DHA) has the greatest benefit for conditions of altered mood and behaviour including:

  • ADHD
  • Depression
  • Bipolar disorder
  • Schizophrenia

Pregnancy, Infancy and Breast Feeding

DHA is necessary for the proper development and functioning of the nervous system, brain, and eyes.  The fetus is dependent on the mother for DHA intake – which must be high enough to meet both the requirements of the fetus and the mother.  Improved DHA levels in mothers and their breast milk is associated with:

  • Improved fertility
  • Decreased risk of premature birth
  • Decreased risk of post-partum depression
  • Improved attention, focus, learning, intelligence and behaviour in children
  • Decreased risk of allergies in children
  • Improved immune development
  • Improved visual acuity

Eye Health

  • Decreased dryness
  • Decreased redness
  • Improved tear production
  • Decreased risk of age-related macular degeneration
  • Decreased risk of cataracts
  • Protection against age-related damage to the eyes

Essential Fatty Acid Supplements

For most people, the preferred form of essential fatty acid supplement is a fish oil supplement.  Vegans may use flax oil as an alternative, but will require higher doses because the conversion to EPA and DHA in the body is inefficient.

Select a fish oil supplement that is:

  • Made from small cold water fish (such as sardines and anchovies) or cod liver.
  • Fresh.  Fish oil can go rancid and should not be used beyond the listed best before date.
  • Adheres to high production standards and performs third-party testing for peroxide, heavy metals, dioxins, polychlorinated biphenyl (PCBs) and other contaminants.
  • Is sustainably harvested.  This means the fish used are not endangered, are not from overfished waters and 100% of fish that are harvested are used for human or animal consumption.

Fish oil doses are dependent on the levels of EPA and DHA and should be individualized according to your individual health requirements.  Speak to a Naturopathic Doctor to determine your ideal EPA and DHA ratio and dosage.  A basic maintenance dose for someone with no major health issues is approximately 500mg EPA and DHA daily.

Disclaimer

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

Selected References

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

Deckelbaum RJ, Leaf A, Mozaffarian D, et al.  Conclusions and recommendations from the symposium, Beyond Cholesterol: Prevention and Treatment of Coronary Heart Disease with n-3 Fatty Acids.  Am J Clin Nutr 2008;87:2010S-2012S.

Freeman MP, Hibbeln JR, Wisner KL, et al.  Omega-3 fatty acids: evidence basis for treatment and future research in psychiatry.  J Clin Psychiatry 2006;67:1954-1967.

Goldberg RJ, Katz J.  A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain.  Pain 2007;129:210-223.

Helland IB, Smith L, Saarem K, et al.  Maternal supplementation with very-long-chain n-3 fatty acids during pregnancy and lactation augments children’s IQ at 4 years of age. Pediatrics 2003;111:e39-44.

Helland IB, Smith L, Blomen B, et al.  Effect of supplementing pregnant and lactating mothers with n-3 very-long-chain fatty acids on children’s IQ and body mass index at 7 years of age.  Pediatrics 2008;122:472-479.

Howe PR.  Dietary fats and hypertension: focus on fish oil.  Ann NY Acad Sci 1997;827:339-352.

Kris-Etherton PM, Harris WS, Appel LJ; American Heart Association.  Nutrition Committee.  Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease.  Circulation 2002;106:2747-2757.

Saldeen P, Saldeen T.  Women and Omega-3 Fatty Acids.  Obstet Gynecol Surv 2004;59:722-730.

Simopoulos AP.  The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases.  Exp Biol Med 2008;233:674-688.

Heartburn in Pregnancy

Every pregnancy is different.  Sometimes VERY different!  When I was pregnant with my first child I had few symptoms (aside from some swelling in my third trimester) and felt vital and healthy for the entire 9 months.  This time around, things are different – and uncomfortable!  I have been having heartburn.

What is heartburn?

Heartburn (also known as indigestion, acid reflux or gastroesophageal reflux disease – GERD) is a burning sensation in the esophagus and can have a number of different associated symptoms:

  • Burning sensation in the chest and throat
  • Sour, acidic taste in the mouth
  • Pain behind the breastbone or between the shoulder blades

Why does heartburn happen in pregnancy?

For a lot of women (me included!) heartburn is first experienced during pregnancy.   About half of all pregnant women experience heartburn.  It can occur at any stage but is most common during the second half of pregnancy.  Hormonal and physical changes both contribute to symptoms of heartburn in pregnancy.

  • During pregnancy, the placenta produces the hormone progesterone which relaxes smooth muscles.  Great for the uterus, not so great for the lower esophageal sphincter (LES) – the valve that separates the esophagus from the stomach.  This relaxation allows gastric acid to reflux up into the esophagus, causing painful burning sensations.  (FYI: this progesterone increase also contributes to constipation in pregnancy.)
  • Later in pregnancy, your baby grows larger and takes up more space in your abdomen.  This pushes upwards on the stomach and forces some stomach acid up into the esophagus.

What can I do about it?

There are many things you can do to manage your heartburn and decrease discomfort.  You don’t need to suffer!  Start with the lifestyle and diet changes, and if they are not effective consider trying some of the other options presented or see a Naturopathic Doctor for an individualized plan.

Dietary Changes

  • Avoid known heartburn triggers.  These are different for everyone but may include carbonated drinks, chocolate, caffeine, citrus fruits, tomatoes, mustard, vinegar, mints, spicy foods, fried or fatty foods.
  • Eat small meals frequently.  Avoid eating large meals and be sure to chew each bite thoroughly (allowing the digestive enzymes in your mouth to do their job.)
  • Limit beverages at mealtime.  Water and other fluids can distend the stomach and force food (and acid) up into the esophagus.
  • Try a sugar-free chewing gum.  This will increase saliva production which can help neutralize acid.  (Note – you may need to avoid mint gums if mint is a trigger for your heartburn.  I find this tip very helpful when heartburn strikes suddenly – and inconveniently – while I’m at work or away from home.)
  • Don’t eat right before bed.   Wait two to three hours after eating before lying down.

Lifestyle Changes

  • Sleep with your upper body elevated with several pillows or a sleep wedge.  This will allow gravity to do its work and keep stomach acid where it belongs.
  • Gain weight sensibly.
  • Wear comfortable clothing that does not constrict your waist and abdomen.
  • Sit upright rather than slouching.
  • Don’t smoke.  If you haven’t quit before pregnancy, book an appointment to discuss your habit with your Naturopathic Doctor now.

Medications and natural remedies for heartburn in pregnancy

For some women, lifestyle and dietary changes are not enough to manage heartburn symptoms in pregnancy.  In these instances a supplement or over-the-counter medication may provide the additional relief needed to get through the full nine months of pregnancy.

Over the Counter Medications

In general I don’t recommend over-the-counter antacids during pregnancy because they don’t address the cause of heartburn (relaxation of the lower esophageal sphincter) but rather function to neutralize stomach acid – a substance that has important digestive properties.

Additionally, some over-the-counter antacids contain aluminum or aspirin (such as Alka-Seltzer) or are high in sodium – all of which are not appropriate during pregnancy.

Generally speaking, the occasional Tums or Rolaid may be helpful – but be sure to check the label and discuss your options with your Naturopathic Doctor or Medical Doctor before taking any mediation.

Supplements and Natural Remedies

As a Naturopathic Doctor I always try to use the smallest intervention necessary to get optimal results.  I recommend starting with all of the dietary and lifestyle recommendations above before you try any of the supplements or natural heartburn remedies listed below.

  • Fresh pineapple can provide quick relief of heartburn symptoms in some people.  Pineapple is a natural source of bromelain and other enzymes.  These enzymes speed digestion and can minimize inflammation.
  • Slippery elm tea is an amazingly effective and safe way to decrease heartburn symptoms and prevent damage to the esophagus.  Slippery elm contains mucilage which soothes and protects the mouth, throat and stomach.  Pour two cups of boiling water over one tablespoon of slippery elm herb or powder, cover and let steep for 5 minutes.  Drink one cup three times per day or as needed.
  • Deglycyrrhizinated licorice (DGL) is a safe alternative to over-the-counter antacids.  It supports proper digestion, increases mucous production in the stomach and helps tonify the lower esophageal sphincter.  Licorice is not safe in pregnancy, however in DGL the harmful glycyrrhizin has been removed, making it a safe remedy for heartburn in pregnancy.  One capsule should be chewed (it must mix with saliva to be effective) as needed.
  • Homeopathic remedies are safe for pregnancy and may be used for heartburn.  Lycopodium is used for chronic indigestion, gas, bloating and heartburn.  Nux vomica for heartburn from coffee or rich foods, or heartburn associated with nausea.

When dealing with heartburn in pregnancy keep in mind that it will end.  Most cases of pregnancy heartburn resolve completely when the baby is born.  So do your best, try some of the suggestions above and look forward to the day when your baby arrives – for more reasons than one!

Disclaimer

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

Selected resources:

Public Health Agency of Canada – Healthy Pregnancy – Heartburn

Aly AM, Al-Alousi L, Salem HA. Licorice: A Possible Anti-inflammatory and Anti-ulcer Drug. AAPS PharmSciTech. 2005; 06(01): E74-E82..

Fertility Diet

Those who take medicine and neglect their diet waste the skill of the physician
~ Chinese proverb

Eating a nutritious diet can boost your health and improve your life in many ways.  For women struggling with issues of fertility, eating properly can boost your fertility and increase the chances of becoming pregnant.

The recommendations below incorporate traditional Chinese medicine and groundbreaking research from the Nurses Health

Study which examined the impact of lifestyle and diet on the health of nearly 20 000 female nurses.  Traditional Chinese medicine (TCM) focuses on bringing the body into balance.  When in balance a woman’s body is naturally fertile and able to nourish both her own body and her fetus.

Fertility Diet Tips

1. Consume a Whole Foods Diet

Whole foods are minimally processed and provide maximum nutrients, fiber, enzymes, antixoidants and taste without added artificial flavours, colours, preservatives, sweeteners or trans fats.

2. Focus on Slow Carbs

Slow carbohydrates are slowly digested causing a slower and more gradual rise in blood sugar after being eaten.  They include beans, peas, lentils, whole grains (such as brown rice, barley, millet and quinoa) and vegetables.  Slow carbs minimize insulin resistance, regulate blood sugar, improve fertility and prevent gestational diabetes. Eliminate all white carbs – white flour, white pasta, white rice, white potatoes and white bread.

3. Eat Primarily Plant Based Foods

Plant based foods include a rainbow of high fiber, high antioxidant fruits and vegetables, legumes, nuts, seeds and whole grains.  A plant based diet means that most (but not necessarily all) of the diet is based on plant foods.  This diet is eaten around the world and is associated with health promotion, disease prevention and longevity.

4. High Antioxidant Foods

A diet high in plant based foods will be naturally high in antioxidant foods.  Fruits, vegetables, herbs and spices decrease oxidative stress and cellular inflammation associated with decreased fertility.  Select primarily organic produce – it has been shown in multiple studies to be higher in antioxidants (and free of hormone-disrupting pesticides!)

5. Consume Healthy Fats and Avoid Trans Fats

Healthy fats combat inflammation and improve hormone sensitivity.  Healthy fats and oils include coconut oil, nuts, seeds, avocados, olives, raw (uncooked) olive oil, and fats found in wild cold-water fish.  Trans fast (also known as hydrogenated or partially hydrogenated fat) – typically found in commercially prepared baked goods, fried foods, and processed snack can disrupt with normal ovulation by interfering with a cell receptor that controls inflammation, glucose metabolism, and insulin sensitivity.

6. Eat Only High Quality Dairy Products

Small amounts of full-fat dairy products daily, such as live culture yoghurt, kefir, and high quality organic goat and cow cheeses have been shown to enhance fertility.

7. Eat Mindfully

Slow down and tune into the nutritive properties of food.  Allow mealtime to be a time when you focus on nourishing your mind, body and spirit.  Mindfulness has been shown to help decrease stress, lower blood sugar and blood pressure, decrease anxiety and depression and enhance well-being.

8. Eat For Balance

In TCM all health concerns are based on an imbalance in the body.  This may be an excess or a deficiency of one of the vital substances or a blockage of energy flow in one of the organ systems of the body.  Your Naturopathic Doctor can help you determine your imbalance and give you recommendations for foods to promote balance (e.g. foods to boost yin or clear heat).

9. Take Supplements Appropriately

Supplements can be used to enhance a healthy diet but should not be used as a replacement for a healthy, balanced diet.  A prenatal multivitamin with iron, calcium, iodine, antioxidant nutrients (A, C, E, selenium and zinc), probiotics, fish oils and others may be used to enhance fertility and support a healthy pregnancy for both mother and child.

Click here for an easily printable PDF copy of the Fertility Diet

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 resources:

Chavarro J, Willett W.  The Fertility Diet.  Harvard Health Publications.  2008.
Lewis R.  The Infertility Cure.  Little Brown and Company.  2004.

Tea and Iron Deficiency

Tea (Camellia sinensis) is one of the most commonly consumed drinks on the planet and is highly respected for its many health promoting properties.  To name a few, tea is:

  • antioxidant
  • anti-inflammatory
  • probiotic (promotes healthy intestinal bacteria)
  • antimicrobial – antiviral, antibacterial and anti-protozoal
  • anti-mutagenic
  • anti-carcinogenic

However, tea can have a significant negative impact on our health as well.   Green tea, black tea, and some herbal teas (such as peppermint) can contribute to iron deficiency. The polyphenols in tea (the same compounds that give tea – especially green tea – many of its health promoting properties) bind to iron and prevent the body from absorbing it.

When tea is consumed at the same time as iron-rich foods the absorption of iron is decreased by as much as 26%.  This impact on absorption is only a concern with non-heme iron, or plant based iron and is not seen with heme-iron (animal-based iron.)  This leaves vegans and vegetarians at greatest risk for the negative effects of this interaction.

In order to prevent iron deficiency it is recommended that green and black teas – including iced teas, not be consumed with a meal and that individuals at risk for iron deficiency (adolescents, pregnant women, vegetarians and vegans, menstruating women, and the elderly) be aware of the potential impact of tea on their iron status.

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.

Pre-Natal Naturopathic Care

Is Naturopathic Medicine safe during pregnancy?

Absolutely!  Naturopathic Medicine is an ideal treatment option during pregnancy.  Although not all Naturopathic treatments are safe during pregnancy, a large majority of Naturopathic treatments are both safe and effective for the common and uncommon health concerns of pregnancy.
Being under the care of a Naturopathic Doctor during pregnancy does not replace the prenatal care offered by a midwife or obstetrician.  Naturopathic care should be used in addition to these services.  Naturopathic Medicine can offer guidance and treatments above and beyond what is offered by your prenatal health care team and can contribute to a happy and healthy pregnancy for both mother and child.

How often do I see my Naturopathic Doctor during pregnancy?

Naturopathic Medicine is an individualized treatment and frequency of visits will be determined based on your current health, changes in your health, personal health goals, and stage of pregnancy.  In general visits occur less frequently in early pregnancy (unless specific concerns such as nausea, nutrient deficiencies, muscle cramps, or insomnia are present) and more frequently in the later stages of pregnancy.

First visit:

The first visit typically occurs prior to pregnancy (during conception planning) or in the first 4-8 weeks of pregnancy.  During the first visit a comprehensive intake and health history will be completed and a nutritional assessment and recommendations are made.

First trimester visits:

The second visit varies, for some women occurring 2-3 weeks after the first visit depending on recommendations made in the first visit.  For the majority of women the second visit is between weeks 8-12 and is the final visit for the first trimester.  Changes to nutritional requirements are discussed and a diet diary is given to track caloric intake for three days. Naturopathic treatments for nausea, appetite changes, swelling, sleep disturbances, or other concerns may be prescribed as needed.

Second trimester visits:

The second trimester is often the easiest for pregnant women.  It is important to maintain regular visits with your Naturopathic Doctor during this stage of pregnancy to ensure continuing health throughout the remainder of the pregnancy.  A visit is recommended around 18-20 weeks and again at 24 weeks.  Between 24 and 28 weeks a glucose tolerance test is performed by your midwife or obstetrician.  You should see your Naturopathic Doctor in the weeks before this test to learn ways to properly prepare for this test.

Third trimester visits:

During the final trimester you may see your Naturopathic Doctor more frequently.  Preparation for the Group B Streptococcus test, treatments for health concerns that arise more frequently during the third trimester as well as acupuncture and herbal teas to prepare the body for labour and delivery are all addressed during the third trimester.

After due-date visits:

Your Naturopathic Doctor will be available to you if you go past-due with your baby.  Acupuncture and moxa (an herb that is applied to warm acupuncture points) as well as homeopathy can be helpful in promoting labour.

Post-natal care:

After the baby is born it is recommended that you and the baby continue to see your Naturopathic Doctor as needed.  Naturopathic Medicine is safe during lactation and for common health concerns in infants.  Your ND can also offer guidance on infant food introduction and appropriate nutritional supplements to support the tremendous growth your child will experience in their first year of life.

Your Naturopathic Doctor may be consulted at any time during the pregnancy if a health concern arises.  Your ND will tailor your pregnancy treatment to your individual pregnancy.  No two pregnancies are alike!  The visit schedule outlined above is just a general guideline.  Your Naturopathic Doctor will recommend a visit schedule that will meet your needs and support your physical, mental, and emotional health, and the health of your baby throughout 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.

 

Too Much of a Good Thing

Nutrients to Avoid in Excess During Pregnancy

Vitamins and minerals are vital in supporting a healthy pregnancy.  However, some nutrients can cause problems when taking in excess amounts during pregnancy.  Make sure you are not over-doing it with these nutrients during pregnancy.

Vitamin A

Birth defects are associated with vitamin A intake over 10 000IU per day.  Birth defects associated with excess vitamin A include malformation of the urinary and genital tract, skull and facial bones and heart.

These defects occur within the first 6 weeks of pregnancy, so avoid consuming more than 5000IU of vitamin A if there is a chance you may become pregnant.

Vitamin C

Vitamin C is safe during pregnancy, but consuming high levels during pregnancy may result in a rebound vitamin C deficiency in your baby following delivery.  Avoid taking more than 1000-4000mg daily to avoid this effect.

Vitamin D

Vitamin D is essential for proper bone and teeth development.  However, excess levels can lead to hypercalcemia which can cause placental calcification and fetal arterial stenosis.

From 20 weeks onward 1000-1200IU daily is recommended to promote optimal bone development of the skull and other bones.  Research shows that this amount also promotes optimal bone mass later in the child’s life.

Proper supplementation is especially important if the third trimester occurs during winter months when inadequate sunlight reaches Canada for skin production of vitamin D.

Vitamin E

Vitamin E can inhibit proper coagulation of the blood and should not be taken in high amounts close to delivery.  Avoid taking more than 800IU per day from week 36 onward to decrease the risk of excess bleeding during and after delivery.

Calciumalmonds are a source of calcium

Calcium is important for both mother’s and baby’s health during pregnancy.  Supplementation can help to prevent pregnancy-induced hypertension and pre-term labour.

However, excess amounts can increase the risk of kidney stones for the mother and can lead to hypercalcemia (excess calcium) of the fetus and placenta.  Avoid taking more than 1200IU daily.

Also avoid dolomite, bone meal and oyster-shell sources of calcium as these may be contaminated with lead.  Instead use professional quality supplements or consume more broccoli, almonds, dark green leafy vegetables, canned salmon (with bones), sesame seeds and enriched soy milk.

Pregnancy is a great time to learn more about nutrients and how they support our health (and the health of our babies).  Naturopathic Medicine is a perfect complement to a natural, healthy pregnancy.  Book a free 15 minute consultation with Dr. Lisa Watson to learn more about how Naturopathic Medicine can support you, your body, and your baby during pregnancy.

Pregnancy – Foods to Avoid

Every mother wants what is best for her baby.  And pregnancy is a great opportunity to start our babies on a healthy diet.

More foods can affect your health and your baby’s health than you might realize.  Understanding what foods to avoid during pregnancy is an important aspect of pregnancy nutrition.

Following these guidelines will help you make healthier choices for you and your baby.

Foods to Avoid During Pregnancy

Raw Meat: Uncooked seafood and rare or undercooked beef or poultry should be avoided due to risk of contamination with coliform bacteria, toxoplasmosis, and salmonella.

Deli Meat and Hot Dogs: Deli meats have been known to be contaminated with listeria, which can cause miscarriage. Listeria is able to cross the placenta and may infect the baby leading to infection or blood poisoning, which may be life-threatening. If you are pregnant and you are considering eating deli meats, make certain that you reheat the meat until it is steaming.

Fish – Mercury and PCBs: Fish can be a great source of protein, iron, and omega-3 fatty acids.  The omega-3s in fish support the proper development of your baby’s brain, eyes, and nervous system.  Research suggests that complete avoidance of fish during pregnancy may contribute to poor verbal skills, behavioural problems, and other developmental issues during childhood.

However, fish that contain high levels of mercury must be avoided. Mercury consumed during pregnancy has been linked to developmental delays and brain damage.  Fish with long life spans tend to contain more mercury than smaller, younger fish.

Farm-raised fish should be avoided due to the significantly higher levels of PCBs – polychlorinated biphenyls.  PCBs can disrupt the normal development of the endocrine (hormone) system.  In addition, farm-raised fish have less nutritional value than wild fish due to the restricted diet they consume on fish farms.

High quality fish oil supplements are rigorously tested for mercury and other contaminants and are safe during pregnancy.

Use the following chart to help guide your fish consumption during pregnancy.

Fish Consumption and Pregnancy

Safe Restricted Consumption

DANGEROUS

  • wild pacific salmon
  • farm-raised trout
  • farm-raised catfish
  • fish sticks
  • summer flounder
  • croaker
  • mid-Atlantic blue crab
  • haddock
  • canned tuna
  • mahi mahi
  • eastern oyster
  • blue crab from the Gulf of Mexico
  • lake whitefish
  • blue mussels
  • cod
  • pollock
  • shark
  • swordfish
  • sea bass
  • tilefish
  • tuna steaks
  • King mackerel
safe to consume during pregnancy limit to approximately one serving per week do not consume while pregnant

Smoked Seafood: Refrigerated, smoked seafood often labeled as lox, nova style, kippered, or jerky should be avoided because it could be contaminated with listeria. (These are safe to eat when they are in an ingredient in a meal that has been cooked, like a casserole.)

Raw Shellfish: The majority of seafood-borne illness is caused by undercooked shellfish, which include oysters, clams, and mussels. Cooking helps prevent some types of infection, but it does not prevent the algae-related infections that are associated with red tides. Raw shellfish pose a concern for everybody, and they should be avoided altogether during pregnancy.

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