A glass of wine with dinner. A beer after a hard day of work. It’s not hard to integrate an occasional drink with a healthy lifestyle. Whole genres of music are written essentially about drinking (I come from a country music family!).

In recent years, we’ve read that red wine is rich with antioxidants, and that an occasional beer can raise “good” cholesterol or stimulate lactation for breastfeeding mamas. But results from a new study suggest that even moderate alcohol consumption - the kind we tell ourselves is healthy - may actually be detrimental to our health. In other words, the much-heralded health benefits of drinking don’t outweigh the risks. As a result, there is no safe level of alcohol consumption.

A recently published research study looks at data collected in almost 700 studies, spanning 195 countries and territories. Some of the findings are startling:

• Alcohol is the leading risk factor for death in the age 15 through 49 age group.
• Alcohol use was responsible for 2.8 million deaths worldwide in 2016.
• For women in particular, the health risks increase with age. Alcohol was responsible for over 27 percent of cancer deaths in women over 50.

The authors of the study are firm in their conclusion: “By evaluating all associated relative risks for alcohol use, we found that consuming zero standard drinks daily minimizes the overall risk to health.”


In other words, the only safe amount of drinks is none at all. This finding differs from many earlier studies, which often concluded that moderate drinking was the best approach.


Why did this study reach a more decisive conclusion than previous examinations of alcohol’s effect on health? Several factors come into play. This study was careful to consider the ways they measured consumption. For example, researchers looked at regional variations in alcohol consumption that could be attributed to things like tourism. In addition, the study looked at alcohol’s impact on 23 different health-related problems. For some of those problems (such as heart disease), mild alcohol consumption had a positive effect. But that positive effect was balanced by a greater negative impact on other health issues (cancer is a strong example).


What does this mean for you? If you drink, should you stop?

Alcohol consumption is a very personal decision. This study looked at the big picture, worldwide. It was not studying individuals, but rather analyzing vast amounts of data previously collected, specifically looking at the risks for the 23 health issues. That data was conclusive. But it’s up to you how you apply it to your own life. This latest study can’t, for example, tell you if it’s OK to have some wine for New Year’s given your own unique genetics and other lifestyle factors.


One thing is clear: If you’ve told yourself that drinking is healthy, you may want to reconsider that rationale. That doesn’t necessarily mean you must immediately quit. However in deciding whether or not alcohol is something you want in your life, it’s best to be realistic about the health risks.


If you’re wondering about alcohol, talk to a healthcare practitioner. And be upfront about your drinking during the visit. Many people underreport how much they drink, but it’s best to be honest. You want to have an open discussion about all of your health concerns. Remember that healthcare providers aren’t looking to judge you: they want to work with you to create your best life.


You also want to look at your own medical history and perhaps check out more specific studies. For example, another recently published study concluded that alcohol is the biggest controllable risk factor for dementia. If you have other dementia risk factors that are out of your control, such as a genetic history, you may want take action on the things you can control.


Similarly, if you have a history of depression, consider alcohol’s impact on mental health. If you are trying to control your weight, the extra calories of alcohol aren’t going to help. Alcohol can also lower your judgment and keep you from making your best decisions.

Alcohol intake may also increase your risk of estrogen dominance, and is a well-established risk factor for breast cancer.

Some patients express frustration at the different results they see in health studies: One minute something is good for you, then suddenly we need to avoid it! Studies on alcohol use can be proof that when we read an eye-catching health-related headline, we need to look beyond the numbers.

​One thing to keep in mind is that the media will typically seize the most dramatic sound bite, although it’s impossible to always convey the nuances of a well-run scientific study in a short headline. For example, a news story doesn’t always mention who funded the study. For the record, the Lancet study on alcohol safety was funded by the Bill and Melinda Gates Foundation, while some others that emphasized alcohol’s benefits were funded by companies who sell alcohol. That doesn’t necessarily mean the studies are false, but we should all remember the funders have a vested interest in how the results are reported. Follow the money!


As well, correlation doesn’t always equal causation. That’s sometimes hard to capture in reporting large studies. In fact there are studies that show that Resveratrol an antioxidant found in red wine is beneficial to your health however if you have other health issues like digestion.htmlpoor gut function, low energy, sleep issues and more, alcohol will likely have negative impacts and could make your health issues worse. One can absolutely gather the benefits of resveratrol by eating organic grapes with the skin on, rather than drinking wine, without negatively affecting other health issues - but that doesn't make for sexy headlines!


Whenever you’re confused about a health issue, the best approach is to consider it from a sample study of one: yourself. That means talking to a healthcare provider about your own personal history and choices and your current health concerns. We can help you sort through all of the information you face every day and figure out what’s best for your unique body, in fact we are experts in doing just that!  

Book your complimentary Health Discovery Consult to discuss YOUR unique health goals.
​

References

1. https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30022-7/fulltext
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874911/
3. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31310-2/fulltext

​Menopause and thyroid dysfunction: one is inevitable for women (if we are lucky to live that long) while the other is common. Both affect millions of women every year.

The thyroid gland, which sits low in the neck, is considered one of the master hormone glands in the body and affects everything from our metabolism, cardiovascular function, the immune system, digestive health, mood and our body’s stress response. The thyroid especially affects our sex hormones.

Menopause typically occurs for most women in their late 40s to early/mid 50s but can also be surgically or medication induced and involves dramatic changes to our sex hormones such as testosterone, estrogen, progesterone, DHEA, and cortisol. As these fluctuate many women start to experience symptoms that we commonly associate with menopause: mood swings, hot flashes, irregular or heavy menses, vaginal dryness and changes in hair and skin. Because these symptoms frequently occur, it is easy to confuse “common” with “normal” and chalk it all up the change. Not so fast.

The thyroid gland acts like the thermostat of the body and is particularly vulnerable under times of stress. Major stressors like giving birth and being post-partum, being a student, mid-life, post-illness or surgery often coincide with major hormonal transitions like pregnancy, puberty, and menopause. When our body is under stress our thyroid gland kicks in to either rev us up or slow us down if we are in danger of burning out. Living a fast-paced life, many of us become susceptible to both sex hormone imbalances and thyroid disturbances.

​If our sex hormones are imbalanced, our thyroid function will be affected and vise versa. For example, depression, weight gain (particularly around the middle), scalp hair loss, body hair growth, menstrual irregularities, poor concentration, osteoporosis, fatigue, insomnia and low libido are common to both hypothyroidism (low thyroid function) and menopause.

Since these patterns tend to be related to stress, it’s crucial to practice stress-reduction techniques and self-care (check out my Calm the F Down Self Care guide here), exercise and eat healthily. More importantly, however, we must determine the cause of these symptoms: poor thyroid function? Sex hormone imbalance? Both? Rather than spending time chasing your tail and taking unnecessary medications, it makes much more sense to determine the root cause of your symptoms.

Getting a proper assessment is critical in establishing YOUR best course of action. In particular, I find the DUTCH Hormone test and a complete thyroid panel especially helpful. You may also want to look into these other tests for fatigue and hormonal imbalance. Often bioidentical hormone replacement therapy can be a game-changer for women throughout the peri-menopausal years and beyond to help restore quality sleep, balance moods and reduce heavy bleeding.

Thyroid and hormone imbalances are common and can be improved when working with a Naturopathic Doctor as part of an individualized treatment plan to age gracefully with plenty of energy as you enter this exciting time of life.

Sound like you? Have questions about your thyroid or hormones? Book a complimentary Health Discovery Session with me to chat more about your options.

In health,

The link here is Vitamin D.

Vitamin D is an essential hormone and we are designed to get lots of it by being outside in the sun, moving around outdoors and enjoying the world around us. The challenge is that many of us spend our days inside working avoiding the sun between 10-2 pm, wearing sunscreen with a high SPF every day under our makeup and long light layers we can become very deficient.

This is a big deal.

Vitamin D is critical for our immune system. Many of us know about Vitamin D for bone health - Vitamin D helps regulate calcium and phosphorus absorption and excretion in the body. This is why many products are fortified with a synthetic version.

Run of the mill health issues like coughs, colds, allergies, flus and other common issues are related to low Vitamin D levels that compromise our immune function. Vitamin D also keeps our immune system communicating so that we reduce our risk of more serious issues like Type 2 Diabetes, osteoporosis, heart disease, cancers and other autoimmune diseases like multiple sclerosis and rheumatoid arthritis. Low Vitamin D is also related to thyroid disease, mental health issues and hormone health. Adequate vitamin D is essential for digestive health as well, and when we are deficient we get leaky gut.

When we lack Vitamin D our immune system loses touch with itself and we are more likely to get sick.

Who is at risk?

• Indoor workers and kids spending the best part of the day out of the sun
• Older adults, who are less efficiently able to generate Vitamin D ​
• Darker skinned individuals
  • The melanin in dark skin actively blocks Vitamin D conversion in the skin, so the darker your tan, the less efficiently you will be able to absorb Vitamin D. Lighter skinned people and babies absorb much more efficiently. ​
• Canadians (the geography effect).
  • We are only able to effectively absorb it from May-October in Southern Ontario
  • This is related to the angle of UVB light coming from the sun. Sunny winter days offer no opportunity for vitamin D.
  • A good rule of thumb is if your shadow is longer than you are tall, you’re not making much vitamin D. 
• Breastfed infants (sometimes)
  • Formula is supplemented with vitamin D so it is thought that breastfed babies are at higher risk of deficiency
  • Mother’s vitamin D status during pregnancy will affect baby’s levels. Mother’s that have excellent vitamin D status and who breastfeed their babies have babies with vitamin D levels similar to that of infants that are supplementing with Vitamin D  
• Concealing clothing, particularly UV blocking, all the time
  • Long layers can be very helpful, however, once you’ve been outside in the sun to help prevent a burn  
• Digestive issues eg. Crohn’s disease, Ulcerative Colitis, Small Intestinal Bowel Overgrowth (SIBO)
  • 25-OH Vitamin D levels tend to be lower in people with digestive conditions, as Vitamin D helps maintain tight junctions within the intestines. With lower levels suggesting immune compromise, these junction become “leaky” and food sensitivities, inflammation and immune activation result  
• Magnesium deficiency
  • Nutrients rarely act in isolation. If magnesium is low, vitamin D absorption is impaired. If Vitamin D levels are low, calcium is not well absorbed either.

Where can you get it?

• Sun – our best source
• Fatty fish, like canned salmon with bones
• Egg yolk
• Mushrooms
• Beef liver
• Fortified foods like dairy, and non-dairy alternatives like almond milk
• *Supplements

 
 
Next Steps:

1. Test your vitamin D (25-OH) to get a baseline
   • Naturopathic Doctors and family doctors can test, however, OHIP doesn’t cover testing, unless you have osteoporosis. It costs about $36 in Ontario to test blood 25-OH Vitamin D
   • Your levels should ideally be around 100-200 nmol/L. Even lower levels within the normal reference range can put you at increased risk for other health conditions
2. ​​Get daily sun, outside in nature.
   1. If you can’t get outside, at least sit near a window
   2. Daily sun time for 10-15 minutes with maximal skin exposure, or roughly half the time it would take you to burn
3. Take a vacation somewhere sunny in the winter
   1. ​Travelling somewhere hot and sunny in the winter months can be helpful, as Vitamin D has a half-life of 2-4 weeks (ie. Your trip to sunny Cancun will help elevate your Vitamin D levels for 4-8 weeks afterwards) 
4. Track exposure via DMinder, a great free app
   1. Can track blood levels of Vitamin D, skin tone, sun exposure and supplement intake so that you know how much vitamin D you are absorbing each "sun session"
   2. I love this option because you also get burn warnings and sunscreen reminders and notifications for your best sun opportunities where you live
5. Be sun smart
   • Know your tolerance.
   • Use shade and wear long layers AFTER you've been out in the sun ie. before you start to burn.
6. ​​Sunscreen should be your LAST line of defense, not your only one!
   1. Use a good quality natural sunscreen that you like using natural blocking ingredients like zinc or titanium oxide.
      1. I like Goddess Garden for beach time, and Cocoon Apothecary Reflector for my face
   2. Avoid sweat-proof, dry touch sunscreens that disrupt hormones, containing ingredients like oxybenzene, retinyl palmitate
      1. High SPF sunscreens do not offer substantially increased protection
   3. Reapply every 1-2 hours and after sweating and swimming
   4. Do your reseach. Check out the Skin Deep Cosmetic Database – a research-driven review of personal care products – publishes an annual sunscreen guide. Check it out to see how yours stack up.
7. If you choose to supplement KNOW your baseline levels
   1. Vitamin D over 1000 IU per day is a prescription in Ontario and self-prescribing is NOT recommended
   2. Work with a licensed health care provider to help determine your ideal levels based on your blood levels and your lifestyle.

 
Vitamin D keeps your brain sharp, skin glowing, immune system humming along and is an essential part of your life. Practice safe sun, but don't fear it!

Keep on the sunny side,

• ​Fatigue is more than feeling groggy because you stayed up too late watching Netflix and missed your morning coffee.

 
It is a persistent ache-in-your-bones feeling, like walking through mud every day and struggling to do the little things. It is the disorientation of not feeling like yourself for the past few weeks, months or years. It clouds your brain, steals your sense of humour and weighs heavily on your relationships. And then there’s the guilt and self-judgement about why you just can’t seem to get it together.
 
One of the biggest struggles that people with persistent fatigue face is that outwardly they look normal. Coworkers, friends and families may offer “helpful” suggestions about being more organized or going to bed earlier (a great point, but not THE point) or completely fail to understand. Even physicians may struggle to help once the basic blood work comes back “normal”.
 
Lifestyle factors can and do play a massive role, so it is critical to ensure that you are getting enough good quality sleep, eating well, exercising, managing stress and taking good care of yourself. Working with a therapist, registered massage therapist, personal trainer and your health team can be helpful to make sure you’re covering your bases.
 
If you are already addressing these areas and still feel like something is missing, Naturopathic Medicine can be a great solution. The next step is digging deeper and doing a thorough investigation to determine the cause of the fatigue and how these factors might be affecting your overall health.
 
Here are some of the most important lab tests that we run to assess the fatigue you’re experiencing.

Ferritin and iron panel – ferritin, % saturation, serum iron and total iron binding

• Iron is essential as it is required to help our body transport oxygen. Adequate levels are critical for optimal thyroid function. Ferritin is a measurement of stored iron and so can be very useful in seeing what’s in the bank. If you are also dealing with inflammation ferritin becomes less reliable as it will artificially inflate. Running a full iron panel can be helpful to discern whether the issue is actually low iron or inflammation.

Vitamin B12

• Low vitamin B12 levels are associated with fatigue, anxiety, depression and other mood disorders as well as neurological sensations like pins and needles. B12 deficiency can be caused by acid blocking medications like proton-pump inhibitors and antacids.

Thyroid Panel – a full panel includes TSH, free T4, free T3, reverse T3 and anti-TPO

• The thyroid sets the pace for every cell in your body aka your metabolism. If this rate is slowed down, everything is going to feel harder and you will most likely feel fatigued, have brain fog, weight issues as well as many other issues. This is one of the most under-diagnosed and poorly managed areas I see in practice. Getting the FULL panel is critical and the only way to give us the full picture.

DUTCH Hormone Test

• This is the most comprehensive hormonal evaluation available and gives a big picture view of how your hormones are working. One of the more common imbalances we see is either very high or low cortisol. This can greatly contribute to fatigue, as well as anxiety, insomnia and is a harbinger for other chronic health conditions. Your sex hormones progesterone, estrogen, testosterone and DHEA also play an important role in keeping you going and even small imbalances here can wreak havoc on your energy and mood.

Autoimmune and Inflammatory Markers – hs-CRP, ESR, ANA, rheumatoid factor, tissue transglutaminase IgG and/or IgA

• Low grade inflammation and undiagnosed autoimmunity as in Celiac disease, Hashimoto’s thyroiditis, lupus, psoriasis, rheumatoid arthritis as well as chronic pain take a lot of your body’s energy to keep under control. Sometimes fatigue is main presenting sign of autoimmune disease. These markers can also serve as a useful baseline to track your treatment progress.

Organic Acids Test

• The Organic Acids test gives us an intricate overview of how your body is physically making energy, if there are any bacterial and/yeast overgrowth concerns, and if you are deficient in some of the major nutrients required to keep your body functioning properly. I highly recommend this test for anyone that has been experiencing chronic fatigue, mood disorders, autism, ADHD and chronic pain.

 
Other factors to consider:
 
You know yourself best. If you feel that something is off, you are probably right. It is better to know where you stand and choose to work with a health care provider that can offer you the evaluations you need to get to the bottom of things.
 
A thorough investigation is important, but it is even more important to have a plan in place to address what you find.
 
Diet and lifestyle factors like how you eat, how you move, how you sleep and managing your stress will ALWAYS need to be a part of any treatment plan you undertake. It can be easy to get caught up in a complicated regimine of supplements and medications, but focusing on a strong foundation is what really determines your outcome.
 
If you have “tried everything”, have you been consistent enough? Being fatigued IS exhausting and it is only natural to get excited about the next newest thing… but nothing will work if you don’t give it a fair shot.
 
You need a team. The support of a partner or friend or online community can make a world of difference when you are suffering from an invisible illness. Work together with your health care providers to get the right assessments and guidance to help you recover. If you feel unsupported, unheard or like you are bothering your provider, find another professional to work with that will take your concerns seriously.
 
Working with a Naturopathic Doctor to address the causes of chronic fatigue can be invaluable to your recovery by helping you systematically address each of the areas above and make a concrete plan based on YOU.

In health,

Creating a strong self-focused morning routine is one of the most important things you can do to set the tone for your day.

Do you find yourself checking your email first thing in the morning and mentally answering questions… hours before you get into work?

Rushing around in the morning, cramming breakfast in your mouth as you drive to work, already feeling that sense of impending anxiety and wishing you had more time for yourself?

Feeling like your day is happening to you?

Me too.

Or rather, I used to feel that way.
As an entrepreneur, I am more than a little obsessed with time management and productivity. As a Naturopathic Doctor, I am all about helping people create systems in their life to reach their health goals so that they can be more successful at work, and be the parent/partner/person they dream of being.

I fell into the habit of auto-piloting my mornings, basing my schedule around when my husband needed to leave for work (ridiculously early), other roommates’ schedules and how much time I could spend falling into the black hole that is my Facebook Newsfeed. I would fly into the office just a few minutes before my first client, feeling a frazzled and unsettled.

It is a recipe for anxiety and unproductivity. You feel like you are constantly chasing your tail and wind up frustrated by your lack of accomplishment at the end of the day. You stay up late catching up… or watching Netflix and always feeling perma-tired.

Recently, I’ve been experimenting with a new “system”. Most successful entrepreneurs, top earners (C-office types) and the calmest people I know get up early. As a night-hawk born of two musicians, this concept is totally alien to me. I’ve gotten into the habit over the past few years, however, due to my husband’s schedule and the desire to spend time together before the day gets crazy. It’s actually very peaceful to be up and moving before the rest of the world. Once I’m up, I never regret it.

Enter the Morning Triathlon: a super efficient start to the day to help you feel healthier, happier and more successful.

Here’s why it works: By starting your day focusing on YOUR needs, you set a strong foundation for the rest of the day. Your email inbox and work day are full of other people’s demands for your time and energy… but by starting and ideally ending the day focusing on yourself, you will feel calmer and more productive.

I call this concept “book-ending”. Ie. You book-end your day getting in the right frame of mind for your day in the morning, and then winding down in the evening.

Here’s how you do it:
​
Figure out how much time you have, and divide into three blocks: Mental, Movement, Mindful/Meditate. This is your Morning Triathlon. Ideally you have about 15 minutes or longer. Skip the time you spend reading the news on your phone.

1. Mental: read something first thing to wake up your brain. Ideally this is something that stimulates or inspires you. The news rarely does, especially lately.
2. Movement: anything to get your blood pumping like jumping jacks, yoga, a quick HIIT work out.
3. Mindful/Meditate: clear your head, visualize your goals and centre yourself for the day ahead.

My morning routine starts like this:

• Mental: I pick up a book – fiction for pleasure, or a research paper, self-development or how-to book
• Movement: a few quick yoga sequences or a quick walk outside
• Mindful/Meditate: I meditate using Muse – the brain sensing headband. Meditations start in 3 minute sessions so it is very time efficient and you get great feedback about how calm or active your brain was during the session
• You can start this before or after coffee/breakfast/shower.
• Just do it. This is the most important part.

Some days I use a 15 minute block of time, other days I have longer. I never regret getting up early or taking care of myself. Self-care is vital to your health.

Get my NEW Guide Calm the F*** Down: 5 Proven Strategies to Take Care of Yourself

In my next blog post, I’ll share with you my favorite ways to build the perfect bedtime routine to help ward off insomnia.

What are YOUR favorite ways to start your morning? Comment below!
 
In health,

Dr. Keila Roesner BHSc ND

When the air starts to get a little chilly and you have a tickly in your throat… and your first thought is “Oh crap..!” what do you do?

When there’s “something going around” and everyone around you has a cold, you might be exposed to any of the following viruses:  Human Rhinovirus (over 100 strains!), Coronovirus (only about 5 infect humans), Human Parainfluenza Viruses, Adenoviruses and Respiratory Synctial Viruses.

While there are plenty of folk remedies out there to ward off the common cold… some more
effective than others.

As a Naturopathic Doctor, I love working with herbs to help support the immune system, reduce congestion and speed recovery time. My favorite herbs to help fight off the common (but inconvenient!) cold include ginger, Echinacea, garlic, and andrographis.

Ginger has long been used in Asia as a “warming” spice to improve circulation. Clinical studies have proven ginger to have some antiviral properties, can be effective against arthritis pain and inflammation and can be helpful for low appetite and nausea. Ginger can also help decrease menstrual cramps!

And it’s always nice to sip on something warm!

You need:

• Fresh ginger root (not dried or powdered!)
• Honey, to sweeten
• Optional (but highly recommended for flavour):
  • 1 apple, chopped
  • Cinnamon sticks
  • ½ lemon, chopped

 
Here’s what you do:

1. Thinly slice ½-1” of fresh ginger root and add to large pot of filtered water. Add other ingredients if using.
2. Simmer on medium for 15 minutes. Strain, into a cup and sweeten with honey.

Sip on 3-4 cups at first sign of a cold and to help decrease joint pain. For nausea, you can drink hot or cold. You can refrigerate the rest in a glass jar and reheat on the stove for a quick cup.

Want to really reduce your risk of getting sick? Sign up for my natural Cold & Flu Support Program.

In health,

 
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.

In health,

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,

Dr. Keila

References
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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

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,

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!