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  Dr. Sarah Connors HBSc, Naturopathic Doctor
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Probiotics and the Microbiome

4/14/2017

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There is so much more discussion about probiotics and the microbiome now than ever before. There is research about the benefits for infants, for mood, for digestion, for re-establishing a healthy gut after antibiotics, and so on.  Even though there’s plenty of evidence to show that probiotics or good bacteria are good for us, a lot of people still ask me ‘does taking probiotics actually make a difference?’ Obviously, my quick answer would be yes they generally do. However, perhaps it’s easier for you to decide for yourself, with a little more information.
The Gut:
Generally when we refer to the ‘gut’ as a collective we tend to think of our abdominal area only. However, the gastro-intestinal tract or GI tract actually begins in the mouth and ends at the exit point, the anus. For our purposes let’s focus on the small intestine and large intestine since that’s where the majority of probiotics have their most beneficial effects.
In the whole GI tract there are over 100 000 billion bacteria. Different species in different numbers populate the gut. This is why it is actually important to change your probiotic on occasion because there are so many different species to be supported. If there are so many bacteria present, how could a few billion make a difference? 
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Well that has to do with the composition and state of the small and large intestine.  There’s anywhere from about 10-100 billion microbes present in the small and large intestine. This helps us understand why giving a probiotic or eating fermented foods makes a difference, because there’s enough probiotics present in the average capsule to replenish and encourage growth of good bacteria. Also, the small intestine is approximate 20 ft long, so it houses about 95% of the bacteria that live in our intestines. The large intestine on the other hand is only 4 ft long, but because things are moving much slower through the large intestine the bacteria layer in the mucosa can be up to 200 cells thick, compared to 1 cell thick in the small intestine. This allows this shorter stretch of organ to still accommodate 10-100 billion microbes. 

Research:
As I mentioned before there are many studies that have been done and are currently being done on the effects of probiotics and the microbiome as a whole. If you did a simple google or pubmed search you would come up with 1000s of results. I can’t summarize all of them, but here are a few highlights:

INFANTS AND PROBIOTICS
Eczema, asthma and allergy have become much more of a problem over the past few decades than they ever were before. In the Swansea baby Allergy Prevention Trial they looked to see if intervening with probiotics at an early age could reduce the incidence of allergy, and atopic conditions by extension. The intervention was given to newborns for the first 6 months after birth. The outcome was a follows:
 
Placebo group: Almost 10% of infants had atopic eczema at 6 months; Approximately 13% of infants had atopic eczema at 2 years.
Probiotic group: Approximately 3% of infants had atopic eczema at 6 months; almost 6% of infants had atopic eczema at 2 years.
 
The overall reduction of infants with allergy was 57% at 2 years. Remember, they only received treatment for the first 6 months. This demonstrates that the positive benefit of intervention goes beyond the intervention period.

PROBIOTICS AND ANTIBIOTICS
Most people are aware that we should take probiotics when we take an antibiotic. However, how much, when and for how long make a difference? One study, The Cambridge Clostridium difficile trial looked at the impact of probiotics to prevent/reduce C. difficile infection and associated diarrhea in patients receiving antibiotics. The outcome was as follows:
 
Antibiotic/Placebo group: When tested at Day 28 they still had overgrowth or dysbiosis present
Antibiotics followed by probiotic: They had a growth of bacteria up to Day 7, but then at Day 28 there was a significant decrease in bacterial overgrowth
Antibiotics with Probiotics: There was no overgrowth of bacteria at Day 7 or 28 because the probiotics were present throughout antibiotic treatment

This study demonstrates that by taking probiotics while receiving antibiotics you can decrease the chances of bacterial overgrowth occurring at all. However, it is still beneficial to intervene with probiotics later on as it will help to bring bacterial overgrowth under control. 
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Gut/Brain connection:
One of the newer areas of study that’s been getting a good deal of attention is the impact that a healthy gut can have on our mood. More and more studies are coming out showing a positive impact of probiotics and healing the gut on issues such as depression, and anxiety. This work is still early, but promising. Promising enough that some companies are actually beginning to make probiotic products specially geared at mood.
Choices: Making sense of what’s available on the market
As happens with most things in the market, as they get more popular there tends to be more people interested in developing a product for it. Over the last few years we’ve seen a huge increase in the number of probiotics available at the store. Knowing you have all these choices, how do you make the right choice for you? Well, there’s no short and easy answer to that. There are a number of factors you want to consider:
  • Do you have any gut problems (eg. IBS or Ulcerative Colitis)?
  • Are you experiencing symptoms such as gas, indigestion, eczema, etc.?
  • Do you have any current allergies or sensitivities?
  • Do you know how many strains are best for you?
  • Do you know which strains are best for you?
  • Do you know roughly how many billion you need?
 
Knowing these things makes it much easier for you to select an appropriate probiotic. If you don’t know the answer to these questions or aren’t sure, then you may want to speak to a Naturopathic Doctor or other healthcare professional. When I go through this process with my patients, we figure out which probiotic (if any) might be best for them so it’s much easier to find what they need when they go to purchase a product from the health food store.
 
 
Have questions about probiotics or how to improve your gut health overall? Please email me through the website ‘contact’ page or get in touch with me directly. 


Note: Talk to your Naturopathic Doctor today about getting assessed and treated if needed, and as always talk to your health care provider before beginning any new medication or supplement. This information is not meant to replace the advice/guidance of a medical professional, nor should it be acted upon by individuals unsupervised by the appropriate healthcare provider.




References:
Allen SJ et al 2014 Arch Dis Child
Plummer et al 2005, Int J Antimicrob Agents 26

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Dealing with Allergies Naturally

3/31/2017

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Finally Spring is here!

The weather is gradually getting warmer, birds are returning, and pretty soon the winter jackets can be put away for another year. The downside for some of us, with these seasonal changes comes allergies! Yes, all the fun you can have sneezing, congested, blurry eyed and unable to breath. However, what if you could do things differently and get them under control naturally?
The Stats
 
In the US:
·  Number of people in the U.S. who have either allergy or asthma symptoms: 1 in 5.
·  Percentage of the U.S. population that tests positive to one or more allergens: 55%.
 
Internationally:
The prevalence of asthma in different countries varies widely, but the disparity is narrowing due to rising prevalence in low and middle income countries and plateauing in high income countries.

Common Symptoms:
 
  • Postnasal drip
  • Sniffling
  • Dark circles under eyes (allergic shiners)
  • Puffiness beneath the eyes
  • Restlessness
  • Fatigue
  • Poor sleep
  • Headaches
  • Behavioural problems such as irritability, hyperactivity, poor concentration, whining, and pickiness about food
Why are they more common?
There is no one theory that currently accounts for the rise in allergies/sensitivities. Some of the proposed causes are as follows:
 
Hygiene Hypothesis: Many children do not get sufficient exposure to a wide variety of microbes, and as result of growing up in an extremely clean environment the body does not learn how to modulate the immune response effectively. There seems to be some credibility for this theory since the significant increase in individuals suffering from allergies has been in the western hemisphere, and we have not seen a corresponding increase in other parts of the globe at the same rate.

Inflammation/Leaky Gut: Chronic inflammation in the body and the gut lining is unable to heal and permits certain food particles to pass through and interact with the immune system. These particles are tagged as ‘non-self’ by the immune system, and it will react to the presence of these particles every time they are re-introduced to the system. Leading to a cycle of continuous inflammation and slow/no healing of the gut lining.

Genetically Modified Organisms (GMOs)/packaged foods: We have altered certain foods in our food supply so much that our bodies have difficulty recognizing it and breaking it down as ‘food’.  There is also a corresponding increase in exposure to preservatives and pesticides that are mixed in or put on these foods.
What Can We Do?
General recommendations:
  • Remove environmental irritants: Rid the home of common irritants such as dust, perfumes and scented products.
  • Improve immune response: There are many things that can be done to help optimize the immune system. Eating a balanced diet of whole foods, including sources of omega 3s and fermented foods for probiotics.
  • Promote rest and relaxation: learning to relax can help decrease tension, and getting to sleep at a reasonable and consistent hour each night can help promote better immune function.
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Dietary recommendations:
  • Identify Food sensitivities:  food allergens (eg. peanuts or diary), and chemicals, additives, or oils in processed foods can cause allergies to be worse
  • Foods rich in Vitamin A and Beta-carotene: the orange and yellow vegetables and fruits tend to be the richest sources
  • Essential Fatty Acids (EFAs): Fish, flaxseeds, eggs, and evening primrose oil all contain EFAs which are essential to health of cells and decreasing allergic symptoms
Supplemental recommendations:
The following nutritional supplements can improve allergy problems in several ways: boost immunity, reduce inflammation, and enhance intestinal health.
  • Zinc
  • Vitamin C
  • Vitamin B complex
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Herbal recommendations:
  • Astragalus: immune system enhancing herb that is a tonic for the upper respiratory passages. Can be directly beneficial for those with a tendency towards atopic conditions such as eczema or psoriasis, commonly occurring in those with allergy problems.
  • Nettle: stimulates lymphatic function, decreasing swollen lymph nodes. In its freeze-dried form, nettle is used to stabilize the inflammatory substance histamine produced by our bodies, thus decreasing allergic response.
  • Elder: This herb has a flower rich in flavonoids, which are anti-inflammatory, anti-oxidant, and immune-stimulating. This combination helps reduce allergic response and improve immune function.
Asian Medicine and Acupuncture
 
  • Chinese medicine considers an allergic reaction to be a manifestation of the body's failure to adjust to its environment.
  • According to the concept of the organs and their functions, weaknesses of the "Lung” or "Liver” could explain these allergic reactions.
  • By stimulating the energy of the "Lung" and by regulating the "Liver" the acupuncture treatment aims to calm the exaggerated response. This can be done both preventatively as well as acutely.
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Suffering from allergies can be a very irritating experience. If you or your child is suffering from allergies, it is best to take them to a Naturopathic Doctor who can perform a proper assessment and form a treatment plan that will address your/your child’s needs. Always speak to your health care provider before beginning any new medications or supplements.






References:
Allergy Statistics and Facts. WebMD. Reviewed by Johnson, K. (2012). http://www.webmd.com/allergies/allergy-statistics
Asthma Statistics. American Academy of Allergy, Asthma & Immunology. http://www.aaaai.org/about-the-aaaai/newsroom/asthma-statistics.aspx
Romm, A. 2003. Naturally Healthy Babies and Children: A Commonsense Guide to Herbal Remedies, Nutrition, and Health. Celestial Arts.
Skowron, JM. 2009. Fundamentals of Naturopathic Pediatrics. CCNM Press. Print.

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The Liver: The Ultimate Eliminator

3/7/2016

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The Liver is really the unsung hero when it comes to our overall health. This organ is so hearty, that you can actually live a very healthy life with only half of a liver. It’s also one of the few organs we have with a robust regenerative capacity, meaning that it can replace cells very quickly and is somewhat resistant to damage. Think of the person who’s been drinking heavily for 20+ years, but they are only starting to have issues with their liver now! Mind you that is not an invitation to abuse your liver.
Why do we care about Liver Health?
One of the most important functions of the liver is to detoxify our bodies. With the popularity of detox diets these days many people worry about the liver’s ability to detoxify, but in fact there’s no need to worry because unless your liver is in the final stages of failure then it’s going to detoxify your body all on its own. Without getting too in depth with the physiology, the liver breaks everything down in two phases, the fat- soluble and water- soluble toxins.
Phase 1 Detox (Fat Soluble toxins) 
  • CYP 450 Enzymes do the initial breakdown and processing of: carbs, proteins, fats, vitamins and minerals
  • First pass effect: all drugs and chemicals entering the body pass through on the way to the rest of the digestive tract
Phase 2 Detox (Water Soluble toxins)
  • Conjugation Pathways (refinery)
  • Refines and filters: some particulates are recycled into the body and others are filtered out of the body into urine, feces and bile
 All this means is that everything needs to be broken down in stages, so it can be effectively recycled or shuttled out of the body in the form of waste (namely urine or stool). If these functions aren’t done properly, this can have profound effects on just about every other system in the body. If the liver isn’t functioning properly then overall digestion, metabolism, hormonal balance and the immune system don’t function well.
 
The Liver performs the following vital functions:
  • Balances cholesterol and blood sugar
  • Creates bile to aid in digestion
  • Produces clotting factors and various blood transport mechanisms
  • Breaks down old blood cells, bacteria, alcohol, and hormones
 
Essentially, without the liver it would not be possible to survive very long.
 
We are living in a Toxic world
We are exposed to all kinds of toxins every day of our lives. From the moment we are conceived, we are exposed to toxins through our mother.  At present, there are over 80,000 chemicals registered by the Environmental Protection Agency.  3,800 are ‘high-use’ chemicals and less than ½ have been assessed for toxic effects in humans.  Less than 9% of these chemicals have been assessed for toxic effects on children. If we don’t take care of our liver’s health, we won’t be able to function in our toxic laden environment.
 
How do we know we’re experiencing symptoms of toxicity?
Well that in and of itself is part of the problem. The overall symptoms of toxicity are quite general, and can easily be mistaken as part of another problem. Some of the symptoms include: fatigue, headaches, muscle and joint pain, mood changes, cognitive impairment and possibly neurological problems.
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Are you susceptible to toxicity?
Multiple factors affect how your body deals with toxic burden.
  • Genetics
  • Diet and nutritional status
  • Lifestyle and individual exposures
  • History of antibiotic or drug use
  • Emotional well-being.

To better understand what toxicity looks like in the body, the analogy I like to use is a bucket.

We all have different buckets, some are short and fill very quickly, or have a spout that doesn’t drain effectively, or perhaps an average size bucket with a decently emptying spout. However your bucket functions, determines how quickly it will fill (accumulate toxins) or empty (eliminate toxins). Unfortunately, those of us with shorter buckets/poorly draining spouts are more likely to build up toxins quickly and/or not eliminate them quickly enough to avoid symptoms of toxicity.
What Can We Do?

Work with a medical professional to help correct problems
  • Naturopathic Doctors can recommend herbs, nutrients, and various other substances as appropriate to optimize routes of elimination. For example, most bitter dark leafy greens that are among the first to come up in the spring (Eg. dandelions and wild lettuces) are great liver cleansers. Adding some of these greens to a salad makes for a happy functioning liver.
Regularly optimize routes of elimination
  • Once to twice a year use easy focused strategies to optimize function of the liver and other organs of elimination (eg. kidneys) to prevent toxic overload. One such strategy I often suggest is a glass of room temperature to slightly warm water with lemon slices first thing in the morning. This helps to get the liver primed and ready to work optimally during the day.
Minimize exposure to toxins everyday
  • Check labels on foods, cleaning products and personal hygiene products. Choose products with low/no chemicals. The majority of pre-packaged food products have some sort of preservative in them to help keep them 'fresh' on the shelf for longer, increasing your daily toxin exposure.




Note: Talk to your Naturopathic Doctor today about getting assessed and treated if needed, and as always talk to your health care provider before beginning any new medication or supplement. This information is not meant to replace the advice/guidance of a medical professional, nor should it be acted upon by individuals unsupervised by the appropriate healthcare provider.
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Discomfort at the Table: When Heartburn Strikes!

4/15/2014

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Gastroesophageal Reflux Disease (GERD)

Many people in the Western world suffer from heartburn on a daily basis. Of those individuals, approximately 20-40% of them have GERD (Gastrointestinal Reflux Disease). The symptoms result from exposure to gastric contents causing esophageal irritation. For most people, the lower esophageal sphincter (LES) is often weakened or other interfering factors can prevent it from closing properly.

Common Causes

-       Functional (frequent transient LES relaxation) or mechanical problems of the LES
-       Foods (eg. coffee, alcohol, citrus fruits) or medications (eg. Calcium channel blockers and nitrates) that decrease the pressure of LES
-       Hiatus hernia
-       Obesity leading to increased intra-abdominal pressure
-       Deficiency of hydrochloric acid (HCl) in the stomach, also known as hypochlorhydria

Symptoms

-       Heartburn, which can be felt after eating, bending over, or lying down
-       Regurgitation, which can sometimes get into the tracheobronchial tree and cause respiratory complications
-       Difficulty swallowing, which produces a feeling that food is stuck
-       Coughing, or wheezing, hoarseness, and non-cardiac chest pain

Conventional Treatment

Typical treatment of heartburn symptoms is the use of antacids (eg. Tums) or stronger medications that can block or suppress the production of hydrochloric acid (HCl).

Naturopathic Treatment

Usually a combination of nutritional, dietary and lifestyle treatment is used to address GERD. If the patient is compliant, usually treatment is very effective.  Almost every GERD patient will need to identify and avoid foods and medications that trigger symptoms.  Most people also find eating smaller meals with more frequency (6 small meals as opposed to 3 larger meals) and not lying down immediately following a meal is also beneficial.

Dietary and Drug Triggers of GERD
Foods that weaken the LES
-       Alcohol
-       Chocolate
-       Coffee
-       Fats
-       Food allergies
-       Mints
-       Onions
-       Sugar

Drugs that weaken the LES
-       Beta-blockers
-       Bronchodilators
-       Calcium channel blockers
-       Cigarettes
-       Diazepam
-       Demerol
-  Nitrates
Nutrients and Herbs

Melatonin: Found to be capable of protecting the esophagus and mitigating the effects of many inflammatory mediators. One study where individuals were treated with melatonin and a few other nutrients (l-tryptophan, Vitamin B6, folic acid, Vitamin B12, methionine, and betaine) or omeprazole, and those treated with melatonin experienced 100% resolution of symptoms compared to 65.7% in those treated with omeprazole.

Phosphatidylcholine (PC): Cell membranes are typically rich sources of endogenous PC, which usually acts as a reservoir for free choline. Free choline is important for acetylcholine synthesis, and acetylcholine has been linked to increased closure of the LES.

Licorice Root (Glycyrrhiza glabra): Considered a demulcent, meaning it coats, soothes and protects tissue. Commonly used for a number of gastric concerns including GERD.

Marshmallow (Althaea officinalis): Another good demulcent and anti-inflammatory herb that is particularly known for soothing inflamed or irritated mucous membranes.


There is no one set formula for preventing GERD, but through proper treatment and working with your health care provider you can learn to manage this condition well. Talk to your Naturopathic Doctor today about getting assessed and treated if needed, and as always talk to your health care provider before
beginning any new medication or supplement.


Note: There are many possible causes of chest pain, including more severe conditions such as a heart attack. If you are uncertain of the cause of your chest pain make sure you see your doctor to get it evaluated as soon as possible.




References:

Godfrey A. & Saunders P.R. (2010) Principles & Practices of Naturopathic Botanical Medicine: Volume I: Botanical Monographs. Central Nervous System, pg. 161-163. CCNM Press.
Prousky J. (2008) Principles & Practices of Naturopathic Clinical Nutrition. Gastroesophageal Reflux Disease (GERD), pg. 126-129. CCNM Press.


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    Sarah Connors

    I am a Naturopathic Doctor and Doula providing care in the Kitchener-Waterloo area. I have a passion for helping people with their health issues and improving the birth experience for Moms, and their babies. I also have a life long love affair with soccer, curling, and the alto saxophone.

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