Dr. Keila Roesner ND
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Are you Estrogen Dominant? Here's What to Do Next.

11/4/2018

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Estrogen Dominance
Estrogen – it’s not a dirty word.

Estrogen plays an important role through the course of our reproductive lives and beyond. It regulates our menstrual cycle, strengthens our bones, controls our cholesterol, and much more. When our estrogen levels go “out of tune” we experience PMS or menopausal symptoms. But even before menopause, varying levels of this vital hormone can wreak havoc. That’s because estrogen requires a delicate balance with other hormones. When that balance is disturbed, we can experience a wide range of frustrating symptoms.

This hormonal imbalance often occurs during a particularly busy time of our lives, the period from about age 25 through to menopause. As a result, our practice sees many women who are dealing with unexplained weight gain, mood swings, and libido problems. But there is help available. A few simple steps can help you restore balanced estrogen levels and feel like yourself again.

How Do You Know if You Have Estrogen Dominance?

Estrogen dominance can impact many areas of our lives, with symptoms that range from subtle shifts to major disruptions in wellbeing. Many women in this age group assume these issues are a normal part of aging or a consequence of their busy schedules. Just because it is common, does NOT make it a healthy normal!

Even a slight imbalance in hormone levels can lead to a number of problems.
Symptoms can vary greatly by person, but often include:

  • Depression
  • Brain fog
  • Memory troubles
  • Insomnia and restlessness
  • Anxiety
  • Irritability
  • Headaches
  • Foggy brain
  • Water retention (sock lines, puffy fingers and wrists) and bloating
  • Increased weight, especially in the belly, hip and bum area
  • Heavier periods
  • More severe PMS
  • Irregular menstrual cycle
  • Fibrocystic and painful breasts
  • Uterine fibroids
  • An increase in fatigue
  • Loss of libido

Does that list look familiar? I see many women in my practice each month with complaints like these. I totally understand how frustrating they can be, especially when you’re unable to find effective treatment. And, of course, the complex relationship between estrogen and our emotions can only magnify the frustration. Who wants to feel irritated about feeling irritable?

It’s not only women who can experience estrogen dominance. You may be surprised to know that men can suffer an excess of estrogen as well. In men, estrogen dominance can manifest a bit differently, with some of these symptoms being common:
  • Enlarged breasts (Man boobs)
  • Sexual dysfunction
  • Infertility
  • Depression
  • Fatigue
  • Midsection fat

What Causes Estrogen Dominance?

To understand estrogen dominance, we have to consider the role of another important hormone, progesterone. Progesterone and estrogen maintain an often tricky seesaw in our bodies. Prior to menopause, the balance shifts at different stages of the menstrual cycle. Estrogen dominance isn’t necessarily a surge of estrogen, but an imbalance in that seesaw. Simply put, estrogen dominance happens when the seesaw tips to one side because there is not enough progesterone to balance out the estrogen. There’s actually no “set” number we can measure that proves an estrogen dominance diagnosis. It’s the overall hormonal profile that is important – the DUTCH test is an extremely valuable tool that I use regularly for assessing this balance.

How does estrogen become dominant? A key factor is the timing. Or, to be more specific, the time of our lives. Consider a normal menstrual cycle during our reproductive years: After we ovulate mid-cycle, our bodies produce progesterone to balance out estrogen.

But as we near menopause, we often have some menstrual cycles when we do not ovulate. As a result, there is not enough progesterone to balance out the estrogen. Enter estrogen dominance -- and its long list of possible symptoms.

To a certain extent, estrogen dominance is a natural part of our aging process. However, recent years have seen a rise in estrogen-dominance complaints, and our busy lifestyle may be a big factor. Environmental and behavior issues can increase estrogen levels, tipping the seesaw even further. What’s to blame? Take a look at this list.

  1. Chronic stress will throw off your hormonal balance, often resulting in excess estrogen. In times of stress, your body produces too much cortisol. Cortisol negatively affects progesterone production, so the result is a shortage of progesterone to balance the body’s estrogen [check out my Calm the F*** Down Self Care Guide here].
  2. Environmental sources of estrogen in our environment, particularly with regard to plastics and pesticides can negatively affect hormone levels.
  3. Excess body fat can increase estrogen levels, since fat cells produce estrogen. Of course, this creates a frustrating cycle for some women, as the fatigue associated with estrogen dominance makes it difficult to lose weight. In men, this excess body fat can convert their testosterone to estrogen... leading to “man boobs”.
  4. When we’re not getting enough sleep, our melatonin levels decrease. And melatonin helps regulate estrogen levels. In other words, if we don’t have enough melatonin to keep estrogen in check, we can end up in a cycle of sleep trouble.
  5. Hormone replacement therapy that doesn’t take all hormones into account and doesn’t treat with customized dosing, can inadvertently create estrogen dominance. Bioidentical Hormone Replacement therapy, when used as part of a comprehensive treatment plan, however, can be a powerful option.

How Can You Restore Hormone Levels?

Our practice can work with you to re-balance your hormonal havoc. Starting with an accurate diagnosis, we can create a lifestyle plan that works for you. As a starting point, these changes are recommended:
  1. Decrease stress. I realize this is easier said than done! But an estrogen-dominant diagnosis might be the wake-up call you need to take a step back and assess your stress levels. Are you doing too much?
  2. Choose your health and beauty products wisely. Xenoestrogens have a similar molecular structure to estrogen. Bisphenol A (BPA), which is often used in plastics, is an example of an xenoestrogen. When these substances enter our bodies, our system reacts as if they are actual estrogen. Some simple steps, such as avoiding plastic food storage containers and products with artificial scents, can help reduce your exposure to xenoestrogens.
  3. Get moving. Exercise will relieve stress levels and could help reduce body fat. Strength training and yoga are great activities.
  4. Get enough sleep. We know - you’re busy. But sleep will help restore your melatonin levels and, subsequently, your estrogen balance. Check out this article for more on improving your sleep quality.
  5. Increase your intake of fiber. Insoluble fiber can bind with estrogen in our digestive tract. Ground flax is another great option. As a result, excess estrogen is eliminated with a high-fiber diet.
  6. Go organic. Many pesticides have been identified as estrogen disruptors. That means they disturb the natural balance of estrogen. Research is still being done in this area, but the connection is becoming clear. Plus, organic food is delicious!

Do you think you might have a hormonal imbalance?

Do the estrogen dominance symptoms sound a bit too familiar? Please contact
our clinic and we’ll get to the bottom of what’s going on and create a plan of action to bring your body back to good health.

References

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC313802
  2. https://www.ncbi.nlm.nih.gov/pubmed/10188197
  3. https://www.ncbi.nlm.nih.gov/pubmed/15276966
  4. https://www.ncbi.nlm.nih.gov/pubmed/11602005
  5. https://www.ncbi.nlm.nih.gov/pubmed/12644393

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Dr. Keila Roesner, BHSc ND

Your Health & Wellness Cheerleader

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10 Obvious Signs Your Body Needs a Reset Detox

10/15/2016

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Your body is ALWAYS trying to communicate with you. The problem is that most of us get so busy that we forget how to listen… so our body needs to scream to get us to pay attention.
 
I hear it all the time. “But Dr. Keila, I’m pretty healthy..”! Meanwhile, you may be taking a few prescription medications to control your blood pressure, thyroid and that random rash that comes and goes. TUMS are in your medicine cabinet and you carry Tylenol in your purse all the time. But that’s all normal, right?
 
Nope. Not at all.
 
There is a BIG difference between common and normal. Common is taking a few prescription medications, having digestive issues and bad knees. Normal is having a good night’s rest, waking with energy and not requiring caffeine. Normal is being able to eat food without feeling awful afterwards, and almost never getting heartburn or headaches.
 
Big difference.
 
Sometimes our body needs a reset. To clear the clutter and figure out what actually is going on.

Here are 10 major signs your body is not functioning “normally” (even though they may be common!).

  1. Your day starts AFTER coffee, and you need it to go to the bathroom
  2. You can’t get through the day without one or two “treats” – be it crunchy, salty and from a bag or sweet and chocolatey.
  3. Your clothes aren’t fitting right OR you have a fat and a skinny wardrobe
  4. You have a noticeable “food baby” bloat after eating
  5. Your skin is acting up and you have acne… and have long passed your teenage years
  6. Weird rashes start taking up residence on your face or body
  7. 3 pm comes and your energy crashes
  8. Migraines or tension headaches are occurring more than once a month
  9. You turn into a dragon-lady just before your period OR you have awful cramps
  10. Insomnia is kicking your butt: you wake at 1-3 am most nights and are exhausted in the morning
 
A good detox should help you address all of these things. It is not meant to “fix” things, but to help your body reset and tune out some of the noise so that you can actually figure out what the heck is going on.
 
Do any of these sound like you? Comment below!
 
If you are tired of these common, but definitely NOT normal signs, here’s three free you can do:
  1. Get your copy of my Starter Detox fridge guide [click here] 
  2. Check out our webinar on how to detox to look & feel great in 7 days
  3. Book a Health Discovery Session with me to discuss your options

If you found this article interesting please share.

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In health,
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The 6 Tests You Need if You Have Irritable Bowel Syndrome.

8/31/2016

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Irritable Bowel Syndrome was traditionally a "diagnosis of exclusion" and often considered if a colonoscopy (checks the colon) and endoscopy (checks the esophagus and stomach) look normal. Basically this means that your physician has hopefully ruled out the scary things like Crohn's disease, ulcerative colitis, and colon cancer and while your digestive system is a mess, you are "normal and healthy".

Time to call B.S.

Irritable Bowel Syndrome: constipation, diarrhea, urgent runs to the bathroom, 3 months pregnant food baby bloating, gas and pain are anything BUT normal. In our previous posts we have discussed some of the most common causes of IBS and some basics to help get you feeling better. 

Personally, I believe that the more information we have, the better you will do. With that information you can create a logical plan to feel better. When you feel better you can work more effectively, spend better quality time with your family and spend less time feeling awful.

While every person is different, here are the 6 most common tests I recommend anyone with Irritable Bowel Syndrome consider:

The Basics:
  1. ​CBC with differential - to check for infections, low iron or vitamin B12, and overall immune system function.
  2. Ferritin & ESR - to check for low iron and inflammation​ which commonly cause fatigue or may indicate infections that should be investigated
  3. Thyroid Panel: TSH, free T3, free T4, anti-TPO and reverse T3 - this group of tests gives us a good idea how your thyroid gland is functioning. If the thyroid is not working optimally any of the symptoms commonly experienced in Irritable Bowel Syndrome can result. Frequently people with thyroid issues will have digestive issues. Ignoring half of the equation will not make you feel better!

Specialized Tests:
  1. SIBO Hydrogen Breath Test - this test assesses hydrogen and methane gases produced by bacteria within the digestive tract. If the test shows elevated gases, you most likely have Small Intestinal Bowel Overgrowth - one of the most common causes of Irritable Bowel Syndrome. 
  2. Comprehensive Digestive Stool Analysis (with optional Parasitology) - *this is one of the most valuable tests you can do to really understand what is going on with your digestive system. This non-invasive test analyzes the bacteria, parasites, how you are breaking down your food and how efficiently your body is working. This test is my number one recommendation if other treatments have not worked.

When you are armed with the right information you can stop wasting time running between doctor's visits, trying expensive supplements that don't work and medications that create other nasty side effects. With the right information you can start feeling better.

If you are ready to start feeling better, please contact me to book your complimentary Health Discovery Session.

In health,

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The real reason your Irritable Bowel Syndrome isn't getting better...

7/20/2016

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What if Irritable Bowel Syndrome (IBS) wasn't "just in your head?". This may seem revolutionary for many physicians... and people that don't have IBS. 

Anyone living with IBS knows it's true. Nobody wants to be bathroom bound when they try to leave the house, or have to scan a restaurant menu frantically looking for the one item that won't cause them pain or embarrassing gas within an hour. 

Well, it's true. 

Small Intestinal Bowel Overgrowth (SIBO) is estimated to be the cause of anywhere from 40-85% or more cases of IBS. Clinically, I would say that this number is even higher.

Your Gut is a Garden

There are several types of bacteria within the digestive system. The particular species depend on things like your genetics, your birth type (hospital, home birth, vaginal, C-section), breast versus formula feeding, your diet, medications and stress. They can change over time and the unique combination can markedly affect how you feel. It can be helpful to classify human bacteria into three categories:

  1. Healthy bacteria  - these are the beneficial species, like Lactobacillus, and Bifidobacterium that help to defend against pathogenic bacteria, producing bile flow, keeping unhealthy bacteria from taking hold, releasing vitamins from our food and metabolizing toxins.
  2. Neutral bacteria (Commensal Flora) - these types of bacteria have evolved along with human species and are generally not harmful. However, given the right conditions they can crowd out beneficial bacteria and create problems.
  3. Unhealthy bacteria (Pathogenic) - these are the typical bacteria we think of: E. coli, C. difficile, Shigella flexneri, Salmonella enterica, Vibrio cholera and they can make us sick, cause food poisoning and long term health issues.

Much like a garden, there are a combination of plants that you want like tomatoes, sunflowers, parsley (healthy bacteria), species that show up that can take over if not contained like mint, orange lilies (commensals) and then there are invasive weeds like bindweed, thistles (pathogenic bacteria). Every garden will have a combination of all of these. As in the human digestive system, we want the balance to be tipped in favour of the helpful species, so that the neutral species can exist in manageable amounts, and hopefully ultimately crowd out the weeds. A diligent gardener can also go a long way.

Normally, the majority of bacteria within the digestive system reside within the large intestine where they work on the food you're digesting to produce Vitamins B1, B2, B6, B12 and K2 as well as other substances. Since we have 10 times as many bacterial cells in our body as we have human cells, even a small alteration in our bacterial garden can change our landscapes dramatically.


Our In House Gardener: The Migrating Motor Complex (MMC)

The MMC coordinates electrical wave patterns every 90-120 between meals that sweeps through the stomach and small intestine to helps propel food and bacteria from the ileum (the end segment of the small intestine) to the large intestine. In order to function properly, our body needs to have a break between meals.

In SIBO, these bacteria can migrate backwards, up into the small intestine which normally has far fewer bacteria. This migration can occur with intestinal permeability, certain medications, inflammatory bowel disease (Ulcerative Colitis, Crohn's Disease), Celiac disease, and low stomach acid.

Because competition is less fierce in the small intestine than in the large intestine [Read my previous blog here to review], these bacteria can settle in, replicate and grow without being crowded. This is like freshly tilling your garden and then going on vacation for two weeks only to find that your neighbour's weeds crept under the fence and have taken over. Now you have thistles that are six feet tall.

The problem is that now you have bacteria existing in high amounts where they would not normally be and they are now crowding out healthy bacteria, interfering with your crop and attracting pests.  The overgrowth can be a combination of healthy, commensal or pathogenic bacteria.... it doesn't really matter because you've got a forest on your hands. 

This overgrowth is what contributes to much of the discomfort of Irritable Bowel Syndrome.
Have you ever noticed that flowers are easily pulled but weeds have deep roots? Same story here. The bacteria that takes hold likes to stick around and make a mess. It can throw off the MMC, and instead of helping to digest your food it ferments it.

Fermentation is the process of converting sugars in foods to gases or alcohol, as in beer, wine and sourdough bread. Our bodies are not designed to ferment, and when we do, we bloat. We get gas pains and "I swear I'm not 3 months pregnant!" food babies after eating. Because the food is not breaking down properly, we also get intestinal permeability.

We are more likely to have other problems too:
  • nausea
  • flatulence
  • diarrhea
  • constipation
  • food sensitivities
  • Leaky Gut
  • Fibromyalgia
  • Chronic Fatigue Syndrome
  • Acid reflux
  • Gastroesophageal Reflux Disease (GERD)
  • eczema
  • rosacea

Sound familiar?

In our next blog post, we are going to be covering the key signs to watch out for to tell if you have SIBO and what you can do about it.

If you found this post helpful, please share with your friends and family!

In happy digestive health,

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Fix my bloat!
Dr. Keila

References
​
  1. Sachdeva S1, Rawat AK, Reddy RS, Puri AS. Small intestinal bacterial overgrowth (SIBO) in irritable bowel syndrome: frequency and predictors. J Gastroenterol Hepatol. 2011 Apr;26 Suppl 3:135-8. doi: 10.1111/j.1440-1746.2011.06654.x. http://www.ncbi.nlm.nih.gov/pubmed/21443727
  2. Mann NS1, Limoges-Gonzales M. The prevalence of small intestinal bacterial vergrowth in irritable bowel syndrome. Hepatogastroenterology. 2009 May-Jun;56(91-92):718-21. http://www.ncbi.nlm.nih.gov/pubmed/19621689 www.ncbi.nlm.nih.gov/pubmed/19621689
  3. Littman DR, Pamer EG. Role of the commensal microbiota in normal and pathogenic host immune responses. Cell host & microbe. 2011;10(4):311-323. doi:10.1016/j.chom.2011.10.004. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202012/
  4. Zhang Y-J, Li S, Gan R-Y, Zhou T, Xu D-P, Li H-B. Impacts of Gut Bacteria on Human Health and Diseases. Sugumaran M, ed. International Journal of Molecular Sciences. 2015;16(4):7493-7519. doi:10.3390/ijms16047493. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4425030/
  5. Deloose E1, Janssen P, Depoortere I, Tack J. The migrating motor complex: control mechanisms and its role in health and disease. Nat Rev Gastroenterol Hepatol. 2012 Mar 27;9(5):271-85. doi: 10.1038/nrgastro.2012.57.http://www.ncbi.nlm.nih.gov/pubmed/22450306
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If You Have Ever Experienced These 5 Things, Your IBS Might Be Caused By SIBO.

7/19/2016

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I had a potential new client in my office today who had been diagnosed by her family doctor with Irritable Bowel Syndrome several years ago. When she asked what she should do next, he told her to "go read about it".

Wait, what?! 

There is so much misinformation online: treatments based on outdated science, "it-worked-for-my-sister's-neighbour" stories and down right bad advice. 

Unfortunately, she did not have a medical degree or background in research to be able to decipher the good from the bad. She knew that the info she was seeing on Yahoo forums was probably questionable, she didn't know where to go to find good information. So she was referred by her pelvic floor physiotherapist to me. "Reading about it" had done nothing for her and she was sick and tired of daily diarrhea.

She is not alone. 

One of the most common causes of IBS is a little known condition called Small Intestinal Bacterial Overgrowth (SIBO) - [read my previous blog post here].

While you should absolutely work with a knowledgeable health professional, there are several tell tale signs that your IBS is actually due to SIBO (and not a deficiency in "reading about it").

5 Key Signs You Might Have SIBO:
  1. Raw fruit and veggies make you feel like crap.
  2. You feel worse on a probiotic.
  3. You haven't felt right since that one bad stomach bug/food poisoning/trip to Mexico
  4. You've had a concussion, and haven't felt right since then either.
  5. You have had multiple rounds of antibiotics or have taken antacids in the past.

If any of these sound familiar, let's set up a time to chat. Book your complimentary Health Discovery Session to discuss your options.

Getting the right testing is the first step to getting better. 

The good news is that there are some very good tests you can do to see if SIBO is causing your IBS. Based on your results, we can create a customized plan to get rid of the discomfort, gas, bloating and bathroom embarrassment. Once and for all.

In my next blog, we will talk about some of the testing you should have to finally get rid of your Irritable Bowel Syndrome.

In health,

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Is your heartburn causing bloating and IBS?

7/6/2016

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Ever had a "Bridesmaid moment"? One of my patients the other day told me about hers. The thing is, she eats exceptionally healthy, exercises, meditates daily and has one of the sunniest outlooks on life I've ever seen. She did not have food poisoning. But her digestive system was a mess.

In fact, she had been diagnosed with Irritable Bowel Syndrome (IBS) and her doctor also suspected Gastroesophageal Reflux Disease (GERD) to be the cause of her vocal hoarseness. She was recommended to take fibre, an anti-diarrhea medication (Immodium) and an antacid. Unfortunately for her, these did nothing to make her feel better.

Irritable Bowel Syndrome is estimated to affect between 10-15% of Canadians (1). I would tend to say that these numbers are extremely conservative because  many people with digestive disorders may not seek care from their medical doctors, or it may take several years to receive a diagnosis. In fact, the vast majority of my clients have one or more digestive concerns.

If you have one digestive issue you are likely to have another. They are not unrelated. This is not a fluke. And you're not going to fix it unless you treat the whole system, or more practically, treat you as a person rather than a collection of mouths, stomachs, guts and colons.

The most common digestive issues that I see and treat are:
  • constipation, diarrhea and a combination of both
  • Irritable Bowel Syndrome 
  • heartburn and H. pylori
  • low appetite (in particular, nauseated and skipping breakfast)
  • food sensitivities (trouble digesting wheat, meat, dairy, MSG, take out..)
  • bloating (5 months pregnant with a food baby?)
  • abdominal pain
  • gas (painful, silent & deadly, or just plain noisy)
  • rectal itching, cuts and bleeding
  • Crohn's disease and Ulcerative Colitis (collectively called Inflammatory Bowel Disease)
  • and the most frustrating, "My doctor says I'm fine but I can barely leave the house because I'm always running to the bathroom!!"). 

Treatment  for these concerns may not be particularly helpful and can often cause additional concerns. For example, Proton Pump Inhibitors (PPI) are commonly prescribed to treat heartburn. Side effects of Nexium (Esomeprazole) a common PPI, include constipation, watery diarrhea, abdominal cramps, stomach pain, and nausea (2). Other PPIs may decrease absorption of calcium, magnesium, zinc, iron and vitamin B12, increase risk of Community Acquired Pneumonia, C. difficile infection, Traveler's Diarrhea, and Small Intestinal Bacterial Overgrowth (3).

Moreover, these medications work by decreasing acid production within the stomach. While this may alleviate heartburn (read my thoughts on this here), this is like cutting off your nose to spite your face. 

The thing is, we need lots of stomach acid. The stomach's job is to burn off parasites, molds, bacteria and viruses to help protect our body from infections. Without a strong acid barrier, our body is not going to be able to protect against these nasty things. In particular, heartburn is associated with Small Intestinal Bowel Overgrowth (SIBO) - a condition of inappropriate types of bacteria hanging out in the small intestine where they shouldn't be. This is relevant because SIBO is conservatively estimated to be the direct cause of Irritable Bowel Syndrome in 40-85% of cases.

That's right, IBS is not idiopathic or in your head. To add more fuel to the fire, a 2009 study showed that people with GERD were 3.5 x more likely to develop IBS and that people with IBS were 2.8x more likely to develop GERD (4). 

So, what can we do about it?

Treat the Cause.
Here are the big priorities.
  1. Rethink the medications. While acid blocking medications may have their place (think ulcers and Zollinger-Ellison Syndrome), and fibre can be helpful they are not the solution. GERD, SIBO and IBS are not caused by a medication deficiency, and to effectively treat the problem, we need to think bigger than chasing symptoms. 
  2. Clean Up Your Diet. We all know that eating crap food isn't going to help the situation. While comfort food is tempting when you don't feel well, it can also make a bad situation worse. Focus on the basics: lots of water, fresh vegetables and fruit, healthy protein like grass fed meat, eggs, beans and plenty of nourishing fats like salmon, nuts, seeds, avocados and coconut oil. Ditch the pop, candy, chips, processed grains and sugars.
  3. Identify Food Sensitivities. Food sensitivities can exacerbate GERD, SIBO and IBS because they add insult to injury. If your body is already struggling to protect itself, adding in reactive foods will increase the burden of stuff that your body has to deal with. Food Sensitivity testing is different than a food allergy and is not commonly tested by medical doctors and allergy specialists. Learn about the differences here.
  4. Practice Good Food Hygiene. Over-eating, eating too quickly and eating on the run are a great way to over-tax your body. Slow down before you eat, take a few deep breaths, chew thoroughly and don't eat while distracted. You will also want to stop grazing and give your body a few hours rest between meals so that it can properly digest. Much like multi-tasking at work is a great way to get distracted and more stressed out, constantly eating and snacking doesn't give your body a break.
  5. Create an individualized plan. To effectively get results you will need to work on the digestive system as a whole. This means supporting, not suppressing. In my practice, we do comprehensive testing to assess food sensitivities, bacterial overgrowth within the gut, stool testing as well as more traditional blood work to gain a complete picture of how your body is functioning. From there we create a customized plan that includes dietary recommendations, stress management techniques and targeting supplementation to strengthen the body to heal.

If you find this article helpful or surprising and would like to learn more, I would love to invite you to book a complimentary Health Discovery Session with me to discuss your options.

In happy digestive health,

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Dr. Keila

References:
  1. Canavan C, West J, Card T. The epidemiology of irritable bowel syndrome.Clinical Epidemiology. 2014;6:71-80. doi:10.2147/CLEP.S40245.
  2. http://www.rxlist.com/nexium-side-effects-drug-center.htm
  3. Johnson D, Oldfield E IV. Reported Side Effects and Complications of Long-term Proton Pump Inhibitor Use, Dissecting the Evidence. Clinical Gastroenterology and Hepatology. 2013;11(5):458-464. http://www.medscape.com/viewarticle/804146_1
  4. Ruigómez A1, Wallander MA, Johansson S, Rodríguez LA. Irritable bowel syndrome and gastroesophageal reflux disease in primary care: is there a link? Dig Dis Sci. 2009 May;54(5):1079-86. doi: 10.1007/s10620-008-0462-0. 
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You Probably Don't Have Too Much Acid: 5 Common Causes of Heartburn and GERD

6/29/2016

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There's a burning fiery pit in your chest. It's not a heart attack. You've checked with your doctor before.
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It's feels heavy, uncomfortable and burns. At your last visit you were told that you probable have GERD. And you think, "what a goofy name for something that feels like hell!"

Heartburn, or Gastroesophageal Reflux Disease (GERD) accounts for one out of three primary care visits, and has been increasing quite dramatically over the last two decades (1). It's now estimated that 18-27% of adults in North America experience heartburn at least once weekly (2), and many experience it daily. Which absolutely sucks.

This sharp increase can be attributed to rising rates of obesity, and is more common amoungst smokers and with age.

Common symptoms of GERD include:
  • sensation of hoarseness or lump in your throat
  • dry cough or throat clearing, last longer than 8 weeks
  • burning in esophagus, throat or chest
  • symptoms worse at night
  • trouble or pain with swallowing
  • bitter or sour taste in mouth
  • nausea and regurgitation
(*most common symptoms, although not all need to be present)

A diagnosis of GERD is often made at the physicians office, and then commonly, anatacids (Gavison, Rolaids, Tums), H-2 receptor blockers (Pepcid AC, Zantac) or Proton pump inhibitors (PPIs, like Prevacid, Losec etc.) are recommended to "stop the burning". If it helps, it is assumed that GERD was your problem. 

But we seem to have gotten a little caught up with this idea that burning = too much acid. If you've read my blog "Why Does My Stomach Hurt?" you'll see that it is a little more complicated than that.

Heartburn typically stems from one of four causes:
  1. abnormal esophageal movements - the esophagus acts like a tube to carry food down to your stomach, via gentle muscular squeezes called peristalsis. Sometimes, these movements can become uncoordinated, resulting in spasms. If there has been long term damage (like strictures), it can really throw off this pattern.
  2. weak lower esophageal tone - the Lower Esophageal Sphincter ("LES", also known as the Cardiac Sphincter) acts as a one way valve from the esophagus down to the resevoir, the stomach. Normally, the LES will stay shut, unless there is pressure from above (hello incoming dinner!) for it to relax and open. Once food passes, it should close up tightly again. However, if the sphincter is weakened from too much pressure within the stomach (overeating, too much carbonation, laying down after meals, extra weight, pregnancy etc.) it may open, causing heartburn. Certain foods, like peppermint, spicy foods, coffee, alcohol can tend to aggravate and weaken the LES as well, but are not the cause.
  3. hiatal hernia - a structural condition where the upper part of the stomach and LES actually sit above the diaphragm, which can constrict the passage of food, weaken LES tone and create a pocket of trapped acid
  4. delayed gastric emptying - more common in women and in people with either Type 1 or Type 2 Diabetes, longer retention of food in the stomach (gastroparesis) can increase pressure within the stomach and thus weaken the LES. This occurs in about 40% of GERD cases (3). 
  5. inflammation - a recent study (4) demonstrated that GERD may actually be caused by a cellular inflammation process, rather than by stomach acid burning the esophagus. It was concluded that if stomach acid were truly the cause of erosive damage to the esophagus, the effected area would be the superficial layers of the esophagus (in contact with food and acid) and appear like chemical burns. Instead, it was found that the damage began at the deeper levels and had the appearance of inflammation elsewhere in the body. 
  6. low stomach acid - acid within the stomach is required to properly break down food and protect our body against illness. Stomach acid production tends to decline with age. However, having adequate stomach acid actually stimulates the LES to stay closed. In absence of enough acid, the LES can tend to relax.. and thus we get splash up.

Very rarely have I ever seen increased stomach acid cause heartburn. Rather, it is most likely a combination of low stomach acid, over-eating and a weak lower esophageal sphincter.

Zollinger-Eillison Syndrome is the only known cause of increased stomach acid, and is a very rare condition where one or more tumours in the small intestine or pancreas (gastrinomas) secrete a large amount of the hormone gastrin which then causes the stomach to produce too much acid (5).

In summary, your stomach is probably not too acidic. But something else is going on, making your uncomfortable. Don't you want to find out.. and fix it?

If you or someone you love is experiencing heartburn and want to treat the cause, please book a Free 15 Minute Health Discovery Session with me.

In our next few blogs, I will outline how to know if GERD is part of a larger puzzle and how you can start improving it naturally.

Until then, happy digesting!

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Let's fix my heartburn!
References:
  1. http://www.medscape.org/viewarticle/560076
  2. http://www.ncbi.nlm.nih.gov/pubmed/23853213
  3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886367/
  4. http://jama.jamanetwork.com/article.aspx?articleid=2521970 
  5. http://www.mayoclinic.org/diseases-conditions/zollinger-ellison-syndrome/basics/definition/con-20024097
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When No. 2 is a No Show.

6/22/2016

1 Comment

 
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Stopped up. Bunged up. Full of it. Constipated. No fun.

Constipation is something I frequently see in practice, and something I notice that tends to effect women, the elderly and people taking more medication more commonly. Increasingly, I am seeing more issues with young women in their teens and twenties.

Typical recommendations are to avoid constipation is to increase water and fibre, and to consume more leafy greens (again, more fibre). But what if these things aren't helping... or are making the sh*tty situation worse?

Before we get into the why and more importantly, what you can do about it, let's back it up (get it?). You will definitely want to check out my digestion post for more in depth specifics on how the digestive system works.

Constipation is defined as infrequent bowel movements that are often difficult to pass and that is lasting a few weeks or more. Many physicians consider constipation to be 3 or less bowel movements per week. On the other hand, Traditional Chinese Medicine and Ayurvedic medicine consider normal frequency to be 1-3 bowel movements per day with any more or less to be abnormal. 

Normal bowel movements should be easy to pass, solid, medium brown in color, with no undigested bits of food, no blood, no mucous, no straining and with only minimal wiping required. Checking your stool every day is a great way to keep tabs on how things are moving.

Constipation can usually be resolved by:
  • Increasing water intake, especially warm water. I like starting the day with a large glass of warm lemon water to help support healthy digestion. Since the majority of your stool is actually made of water, dehydration can definitely make for slow going.
  • Easing up on the caffeine. Coffee acts like a laxative and may create dependence. It is best minimize so your bowels can work on their own.
  • Regular walks and exercise. The movement of our psoas, quadratus lumborum, and abdominal muscles can increase circulation and stimulate your colon.
  • Increase dark leafy greens and other vegetables in the diet. These turn into soluble fibre and will help lubricate the colon to move.
  • Add or back off on insoluble fibre like psyllium, bran and others. These fibres are important to bulk up the stool, but in too high amounts without an increase in water they can sit like a brick. Experiment to see what amount feels good for you and drink lots of fluids.
  • Stress Management. When we are constantly running around, eating on the run with a million things on the brain it can be hard for our body to let go. Practice meditation, allow yourself time to sit on the toilet each day, ideally in the morning, for several minutes without interruption. Yoga, counseling, music and building in down time into your day can also help relax the body.
  • Acupuncture and Massage. Both can work wonders to gently move things along without creating a dependence.
  • Sparingly using laxatives. Frequent laxative can create dependence. While they are sometimes necessary, it is better support the body naturally to get moving and save these only for especially stuck times. 
  • Fixing your posture. Sit with a stool in front of the toilet so that your legs are elevated into a squatting position. This will help align the colon in a more natural shape for efficient elimination.
  • Ruling out other causes. While constipation happens to all of us from time to time, it can also signal other medical issues. 

Constipation can also signify:
  1. lack of exercise ("Vitamin Move")
  2. dehydration
  3. hypothyroidism and autoimmune thyroiditis (Hashimoto's Disease)
  4. Food sensitivity
  5. Irritable Bowel Syndrome
  6. Hormonal imbalances
  7. Small Intestinal Bowel Overgrowth
  8. Hemorrhoids, fistulas
  9. Poor pelvic floor muscle tone (or too much muscle tone)
  10. Food hygiene habits

If you are experiencing frequent or long term constipation, be sure to check with your doctor or Naturopathic Doctor or pelvic floor physiotherapist to rule out the conditions listed above.

You can also book a Free 15 Minute Health Discovery Session with me to learn about your options.

In health & smooth moves,
​

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Why does my stomach hurt? Here's How to Hack Your Digestive System

6/15/2016

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"My stomach hurts all the time", lamented my third client. That is, my 3rd client today alone. She continued, "I'm bloated all the time, even with healthy food. I'm constipated, then I have loose stool. I never feel like I'm getting everything out!". I also work with her father, who has heartburn, a "noisy gut" and suffers from urgent abdominal pain any time he has to go outside of the house.

2 out of 3 clients I work with have digestive issues. 

As long as I can remember, I have had abdominal pain while eating dinner. My immediate family all suffer from Irritable Bowel Syndrome ("Ass Crisis", as we've affectionately deemed it). I have had a vested interest in learning and working with the digestive system from the day I saw my first client.

Fortunately, I have found that most "gut problems" respond extremely well to Naturopathic medicine. If you, or someone you love, has been suffering, this post is for you.

The Digestive System - more than just your stomach

The digestive system encompasses everything from your mouth down until you see it in the toilet (hopefully) the next day.

The Head
Digestion starts in the brain, evoking a physical response long before food passes your lips. When we think about food, envisioning how it will taste and feel and actually let ourselves feel hungry, our body gets to work increasing saliva, stomach acid and digestive enzymes. Like a good seduction, digestion is as much a head game as the act of doing it.
​
Problem Zone 1: eating mindlessly, not letting yourself get hungry, eating in a rush, over-eating etc. so that your body doesn't have time to catch up

The Mouth
Chewing your food thoroughly accomplishes two things:
  1. Mechanical break down of your food into smaller pieces for further break down later on
  2. Secretion of amylase, an enzyme in saliva that helps to break down starches in food

Problem Zone 2: eating without thoroughly chewing, drinking large amounts of fluids with meals that may dilute your digestive enzymes

The Esophagus
The esophagus is a flexible tube that carries food from your mouth to your stomach. At the bottom of the esophagus/top of the stomach is a muscle called the lower esophageal sphincter or the cardiac sphincter. When it opens it allows food from the esophagus in the stomach, otherwise it should stay shut to prevent splash up of acid causing heartburn.
 
Problem Zone 3: eating too quickly so that food gets stuck or the stomach becomes overloaded; heartburn that creates pain in the esophagus

The Stomach
In the stomach, hydrochloric acid (HCl) is produced by the parietal cells in the stomach. Another enzyme called pepsin begins to work on the food as well, breaking down protein. An acidic environment is required to breakdown our food and prevent pathogens (bacteria, fungi, parasites and other food borne illnesses) from taking hold. After churning in the stomach, the partially digested food (now called chyme) moves past the pyloric sphincter at the base of the stomach and empties into the upper small intestine.

Problem Zone 4: inadequate stomach acid causing poor digestion of food, heartburn and increasing risk of illness, ulcers

Liver/Gallbladder/Pancreas
As food enters the upper portion of the small intestine, it passes nearby to the liver, gallbladder and pancreas, which all make enzymes to help us digest fats, proteins and carbohydrates (lipase, protease, amylase and others like lactase for digesting lactose, renin, sucrase etc.). This will result in further breakdown of our food.

Problem Zone 5: inadequate fat in diet to stimulate production of lipase and bile, not enough protein in diet to make these enzymes, blood sugar issues that compromise the pancreas' ability to manufacture amylase and keep blood sugar in check, poor functioning of the liver and gallbladder

The Small Intestine
The small intestine has three parts: the duodenum, jejenum and ileum and collectively is about 6 meters (20 feet) long in humans. As it passes through each of these, food interacts with the lining of the intestines, is absorbed and utilized by the rest of the body. Nutrients from our food are absorbed along the small intestine and breakdown continues.

Problem Zone 6: food sensitivities create inflammation along the lining of the small intestine resulting in poor digestion and impaired absorption of nutrients. These can create very dramatic digestive symptoms, and malnutrition.

Colon Issues
The mostly digested food enters the large intestine, where water is reabsorbed back into the body along much of its 1.5 meters (5 feet). Different kinds of bacteria work on breaking down the remnants here.

Problem Zone 7: poor bacteria in the colon can cause bloating, gas, distention and pain.

Rectal Issues
Finally, stool exits the body. Stool is mainly water, combined with food remnants, dead bacteria and cellular waste. If there is inflammation here or in the colon, the remaining material may not be broken down properly.

Problem Zone 8: Hemorrhoids and anal fissures (small cracks around the anus) can block the passage of stool and create pain, bleeding and tearing of the delicate tissue.

Putting It All Together (The Digestive Dream!):
You feel a rumble in your belly, and realize it's lunch time. You start to think about your lunch, looking forward to what you are about to eat. As you are heating it up, you take a few deep breaths, happy to have a little break. When your food is ready, you sit down at the table, looking at the plate in front of you. You say grace, or take a few more deep breaths, looking forward to savouring the meal instead of wolfing it down, even though you are hungry. You chew your first few bites slowly, enjoying the taste and texture of the food in your mouth. You have a a sip or two of water - but just enough to moisten your mouth - and enjoy your meal. Maybe you chat with your family or coworkers, or your enjoy the fresh air outside or the nice music in the background for a leisurely 20-30 minute meal. Work and the rest of the afternoon are the last thing on your mind. When you finish, you feel good. Your belly feels happy: flat, pleasantly full and quiet. In between meals, you sip on lots of water. Sometimes fresh water, other times you opt for herbal tea. You make sure to get lots of breaks in at work to move around, and enjoy a daily walk. You have 1-3 bowel movements each day that are very easy to pass, formed, in one piece. Afterwards you feel great. ​
Top 10 Tips to Hack YOUR Digestive System:
  1. THINK about your food before you eat - how it looks, smells, will taste, how it was prepared
  2. Pause before eating. Say grace, take 3-5 deep breaths.
  3. Take 1 tsp-1 Tbsp of raw, unpasteurized apple cider vinegar 10 minutes before meals, to help improve stomach acidity. Digestive bitters and other supplements recommended by your Naturopathic Doctor may also be helpful.
  4. EAT and ONLY Eat. No distractions - TV, phone, computer. This will help avoid over-eating, under-chewing and promote better digestion.
  5. Chew your food thoroughly until is it liquid before swallowing. A good rule is 10 chews per bite of food.
  6. Avoid liquids before and with meals, except to moisten mouth. This will help to avoid dilution of stomach acid and enzymes so that they can work effectively.
  7. Take your time eating. Enjoy your meal.
  8. Don't eat when stressed, angry or emotionally upset. Eating, like any other kind of work, can be affected negatively by a negative state of mind.
  9. Check your stool. Is it formed, watery, soft, sticky or breaking apart? Knowing these details makes it easier for other health care providers to assist you.
  10. Test your Stool Transit Time every few months. On an empty stomach in the morning, take 2 Tbsp of white sesame seeds, chewing lightly before swallowing. Then time how long it takes before you seem them again in your stool. This will give you a rough estimate of how long it takes food to pass through your system. Retest in a week to see if this varies.

If you experience gas, bloating, heartburn, diarrhea, constipation or other digestive concerns and are interested in learning more, please schedule your Free 15 Minute Health Discovery Session with me.

In health & happy digestion,
​
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    Dr. Keila Roesner is a Naturopathic Doctor. When not treating patients she is also an enthusiastic barefoot-strolling, music-loving, yoga-doing kitchen wiz - who also happens to be a wrestling fan.

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​Dr. Keila Roesner, BHSc ND
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