Natasha Klemm ND

Combining the wisdom of nature and art of science, Naturopathic Medicine is your healthcare solution.


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The Medicalization of Menopause and Your Treatment Options Part 1

Recent “expert” recommendations for the flu vaccine in pregnant women got me thinking. Many health conditions experienced by women—immune fluctuations in pregnancy, hot flashes and mood changes in menopause—have become “medicalized” or “diseaseified”. Natural changes in hormones, which undoubtedly have an effect on our wellbeing, become diagnosed as illnesses within the medical community, leading to, of course, the development of new pharmaceutical drugs…

Time and time again, I see that women are given unnecessary pharmaceuticals before natural and effective treatments are tried. Oftentimes, these drugs relieve symptoms, but create additional health problems, requiring even more medication and the vicious cycle continues.

Hormones, bio-identical and conventional, are prescribed to mitigate the symptoms of menopause—hot flashes, lowered libido, vaginal atrophy, mood changes, insomnia, fatigue and weight gain. Patients are often confused about the difference between the two, seeing conventional as “bad” because of serious side-effects, while bio-identical hormones are seen as a miracle therapy—all the benefit with no risk. But as with any therapy, risks are possible.

Categories of Hormone Replace Therapy

There are three main categories of hormone replacement therapy. Bio-identical Hormone Replacement Therapy (BHRT), aka natural hormones, is derived from plants and is structurally identical to human hormones. For example, estrogens are derived from wild yam and soy—two plants used in herbal medicine to reduce menopausal symptoms. These hormonal preparations differ from the horse-derived estrogens used in conventional hormone replacement therapy (HRT). Conventional HRT is synthetically produced in a lab and is structurally different from human hormones.

The major concern with HRT is that the synthetic structure is broken down and detoxified differently than natural hormones. These breakdown products may be more harmful or linger longer in the body, having a greater impact on tissues.

“Friendlier” hormone replacement therapy is similar to bio-identical hormones, but includes binders, fillers, preservatives and additives in the formulations.

Estrogen (include conversion diagram)

Three types of estrogen are produced in the body and differ in structure—estriol, estradiol, and estrone. Estradiol, made from male sex hormones, is converted into estrone. Both these hormones are converted into estriol, which is the estrogen form of choice for prescribing complementary medical practitioners.

Estriol has both estrogenic and anti-estrogenic effects in the body, similar to soy (don’t worry, this will be discussed in the next blog). A number of studies have demonstrated improvements in hot flashes, insomnia and vaginal atrophy after 3 months of bio-identical estriol therapy. The majority of data indicate the intravaginal estriol does not have an effect on the endometrium, and long-term oral use also does not increase the risk of uterine cancer. Estriol therapy can improve cholesterol levels and bone density—two common concerns for post-menopausal women. While the effects of estriol on breast cancer growth are conflicting, the risk appears to be dose-dependent.

Conventional estrogen therapy has much greater health risks with long-term use. When taken with or without synthetic progesterone, there is an increased risk of developing invasive breast cancer, blood clots, heart attacks and stroke. Without concomitant progesterone therapy, there is a greater risk of uterine and ovarian cancer.

Many women are given either hormonal therapy to treat hot flashes and mood changes, only to end up gaining more weight. The Rx creates a relative estrogen dominance in the body, which blocks thyroid receptors and impairs thyroid function. This leads to a sub-laboratory hypothyroidism and subsequent weight gain.

Progesterone

Unlike estrogen, whose production falls to 40-60% of premenopausal levels, progesterone levels decline to nearly zero during menopause. Progesterone has anti-estrogen properties, normalizes water retention AND facilitates thyroid function and blood sugar balance.

Natural progesterone can be administered as a cream, oral capsule, sublingual drop or pellets, lozenges, transvaginal and rectal suppositories and injection. The route of administration is determined by the severity of symptoms and other medications, such as estrogen therapy. Natural progesterone creams are used to reach normal physiological levels to reduce menopausal symptoms, but do not provide adequate protection from uterine cancer when estrogen is taken as well. The research is conflicting on its impact on breast cancer risk; some studies show greater risk, while others show protection. Similarly, progesterone does not prevent heart disease or osteoporosis. The most common side effects of progesterone therapy are breast tenderness, water retention and bloating, irritability and cramping.

Testosterone

After a woman has entered menopause, testosterone production decreases by 50%. When this male hormone is included with estrogen replacement therapy, greater improvements in hot flash severity, sexual desire and sexual satisfaction are seen compared to estrogen replacement alone. Testosterone may improve bone density in post-menopausal women, but has a potential worsening outcome on cholesterol levels.

DHEA

As the precursor to testosterone and estrogen, DHEA is another sex hormone worth mentioning. Animal studies show benefits on immunity, bone density, cancer prevention, brain function and cardiovascular disease, but human studies show negative effects on cholesterol and no improvements on bone density. Clinically, this hormone is used to increase overall wellbeing, especially in postmenopausal women with fatigue and low libido, but it can cause acne and facial hair growth in women, and effect hormone-dependent cancers.

The bottom-line is that when we see menopause as an illness, medications become overutilized and this unfortunately causes an increased risk of true medical illnesses, such as cancer. Medicalization of menopause places each woman into the same proverbial box and does not account for health factors, such as diet and nutrient status, activity level, stress and mental health, on the severity of these symptoms. Instead of Band-Aids for the superficial boo-boo, build a foundation of health. If you don’t need hormones, then don’t start.

Next blog…Stay tuned for the comprehensive naturopathic approach to menopausal symptoms that should always be tried first!


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Histamine Intolerance – More than a runny nose and sneezing!

Every few months I experience an “aha” moment. I moment that arises on a quest to understand more about the body and what drives disease. A moment that arises when a patient is no longer getting better and I refuse to give up. Besides the obvious fulfilment I get from seeing patient’s everyday, it is these moments of clarity that cause me to fall in love with naturopathic medicine, over and over again.

The most recent proverbial light-bulb went off during my research on histamine intolerance. If you have suffered from allergies, you are aware of histamine and its annoyingly debilitating effects,—itchy throat and eyes, sneezing, runny nose, hives—which are treated with anti-histamines. If you have suffered from heartburn, you may have taken histamine antagonists to prevent the release of stomach acid. But it doesn’t stop there!

If you suffer from intense menstrual cramps, you may have a histamine intolerance. Easy bruising? Skin flushing? Also caused by histamine intolerance. Are you anxious, depressed and/or have difficulties sleeping? Then you may also have a histamine intolerance.

As a naturopath, my role is to determine the mechanism or thread that ties all symptoms together and quite obviously histamine intolerance is a thread.

Histamine is derived from the amino acid, histidine and in addition to its release by mast cells from your immune system, it is also produced in certain foods and gut bacteria.

There are 4 types of histamine receptors found throughout the body, resulting in a variety of effects and symptoms. Within smooth muscle, histamine causes contraction, leading to pain. It increases stomach acid production, resulting in indigestion and diarrhea. The production of histamine occurs at the expense of other amino acid derivatives, such as serotonin, melatonin and dopamine, thus causing mental illness and insomnia. And by causing dilation and increased permeability of blood vessels, histamine leads to skin flushing, low blood pressure and bruises that appear out of nowhere.

The issue with histamine intolerance is that it develops insidiously, as a result of multiple exposures to allergies, histamine-containing foods and bachistamine-problemsteria. Foods can either contain high amounts of histamine or histidine or they can cause the release of histamine in the body. Wine and champagne is the worst . So take the summer for example, aka outdoor wedding season…Pollen, check; champagne toast, check; wine with dinner, check! And your body starts filling with histamine. Now lets add the gut bacteria component to really tip the scales.

Our digestive system is inhabited by trillions of bacteria that help us fight infection, absorb nutrients, breakdown food AND breakdown or build-up histamine. But what happens when you have digestive problems? Bloating, gas, irregularity and stomach pain…all signs of an imbalance in your gut flora and many times, an overgrowth of histamine-producing bacteria! Instead of bacteria that helps, you have bacteria that hinders.

Lastly, an important enzyme that breaks down histamine, DAO, is produced in the gut. If your gut is not functioning well, this enzyme is not being produced adequately—its that simple. And many medications and foods prevent its production as well.

Wow, that sounds horrible and irreversible and inevitable. Can anything be done?

You bet!

Since the development of histamine intolerance involves many factors, so does treatment.

First, is to eat a low-histamine diet. Avoiding smoked meats and aged cheeses, alcohol (which also hinders DAO production), shellfish, vinegars, certain nuts, and chocolate is key to limiting further histamine exposure. Supplements, including probiotics, are required to prevent histamine release from mast cells and promote its breakdown. Clinically, improvements are seen within 4 weeks, but complete healing can take longer as the gut is healed.

Histamine intolerance is the perfect example of the interconnectedness within our body. With most diseases it is a game of “chicken or the egg” in determining what happened first, but it is never difficult to see how things are linked or the theme that binds your symptoms together.


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The 10 Commandments of Healthy Eating

Heartburn, bloating, gas, and irregularity – all very uncomfortable feelings that indicate your digestive system is not working properly. The gut is a complex system of organs, enzymes and compounds that function to digest food and absorb nutrients. But time and time again, I see this vital system not functioning optimally. While an imbalance can occur from food sensitivities, antibiotic use, microorganism overgrowth and reduced digestive enzymes, many symptoms of digestive upset are related to the lost art of dining.

Gone are the days when our meals were taken at the exact same time everyday and eaten at the dinner table with minimal technological stimulation. Instead, we eat on the run, in front of the TV and even skip meals all together, leading to an upset tummy and weight gain. We need to re-establish those 1950’s eating patterns so that our gut and waistline are happy.

10 Commandments of Healthy Eating.77262-400x265-Healthy_Eating_Plans

  1. Eat only when hungry
  1. But, do not wait until you are starving to eat. You will end up eating a lot faster, which prevents the “satiated” signal from getting to your brain and you will choose more high-calorie vs nutritious foods.
  1. Eat only when seated, and not seated in front of a computer or television, but at a table.
  1. Eat slowly and chew your food, putting down your utensils between each bite. Savour each bite by using all five senses.
  1. Leave room on your plate. If you fill it with food, you may feel obligated to eat everything, despite feeling satiated. And it is OK to leave food on your plate if you are full!
  1. Before reaching for a second portion, wait 10 minutes. This allows time for your brain to get the message that your stomach is full. If you are still hungry, have equal portions of protein, vegetables and carbohydrates.
  1. Stop eating at 8 pm or do not eat for 12 hours after having a late meal. For example, if you eat dinner at 10 pm, do not have breakfast until 10 am.
  1. Do not eat when you are angry, upset or stressed. This stimulated state impairs the release of digestive enzymes and not only leads to indigestion, but also ulcers and heartburn if chronic.
  1. Limit fluid intake to 15 minutes before and 15 minutes after your meals as liquids dilute your digestive juices and reduce their ability to breakdown and process nutrients.
  1. Prepare your own food. This is the first step in enjoying food via smell, taste and sight and it stimulates the digestive system to work optimally.

Food is all about nourishment and enjoyment, but not comfort. Savour and revel in the art of dining, enjoying every deliciously, nutritious bite!


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Are protein bars really healthy?

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By Natasha Klemm ND

Promoted as healthy meal substitutes, protein and nutrition bars are a billion-dollar health food business. Labeled as “70% organic” or “all-natural”, many people consume them as part of a healthy weight loss plan. But are they really good for you?

Protein is a vital component to healthy weight loss, right? So it follows the logic that eating protein bars, which contain specified caloric amounts, can aid weight loss while providing you with necessary nutrients. Unfortunately, this is not always the case.

On average, everyone should be having around 25 grams of protein with each meal. Many protein bars contain less than 10 grams of protein. In addition, some protein bars contain upwards of 29 grams of sugar, that is OVER 7 teaspoons of sugar in one serving. With little protein and lots of sugar, your blood sugar yo-yos, leading to dips in energy and quick hunger, in other words, you eat more. And don’t forget that excess sugar is converted into fat. Thus, those meal replacement bars can actually cause weight gain.

Protein bars that pack the most punch are derived from dairy protein, providing up to 30 grams. But the protein is either a whey protein isolate or concentrate, which contains very high levels of free glutamic acids. In the body, glutamic acid is converted into monosodium glutamate (MSG), an excitotoxin that causes allergic reactions, facial swelling, headache, flushing, and chest pain in otherwise healthy people, and it has been linked to autistic symptoms.

For vegetarians and vegans, there are protein bars derived from soy. These are no better since the soy protein isolate contains just as much free glutamic acid. Soy is one of the most genetically modified (GMO) foods, which may have toxic effects on the immune system, liver, pancreas, kidneys and reproductive organs. Soy is difficult to digest and forms opiate-like molecules that act on reward centers in the brain, causing food addictions, changes in mood and difficulties concentrating.

Labeled as “whole nutrition” or meal replacements, these bars are fortified with synthetic (think unnatural) nutrients that the body has difficulty utilizing. Some synthetic nutrients are even associated with increased disease risk and mortality, an example being dl-alpha tocopheryl acetate, a form of Vitamin E.

Check out these protein bars and decide if they are healthy:

Luna Chocolate Chunk is promoted as a Whole Nutrition Bar for Women. It is labeled as 70% organic and contains calcium, vitamin D, folic acid and iron. This bar has only 9 grams of protein, which is derived from soy protein isolate.

Clif Chocolate Chip is similar, labeled as 70% organic and has 9 grams of soy protein isolate. It contains non-organic soy lecithin (i.e.: GMO) and dl-alpha tocopheryl acetate. It is fortified with synthetic B12, which is poorly absorbed and utilized. And it contains the equivalent of 6 teaspoons of sugar!

Supreme Chocolate Chip Cookie Dough provides 30 grams of protein derived from whey and soy protein concentrate. It contains maltitol, an artificial sweetener that causes abdominal pain, diarrhea, flatulence, and gas. Used as a sugar substitute, it is very high on the glycemic index, which raises your blood sugar rapidly.

Protein bars are often used in a pinch, when hunger strikes. But the additives and isolates prove more detrimental to your health. Have boiled eggs and carrots or nuts and fruit as a snack, avoiding protein bars as meal replacements. The bottom line…eat whole foods, not protein bars.


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Curb your sugar cravings!

 unnamedHighly-refined sugar, such as table sugar and high-fructose corn syrup, is kryptonite for optimal health.Consumption increases the signs of ageing, weight gain, fatigue, bone loss, insomnia, mental fatigue and depression.Furthermore, key nutrients, including magnesium and calcium, are lost with sugar consumption.

Despite knowing sugar’s negative health consequences, we often find ourselves uncontrollably eating chocolate or sweets, unable to curb our cravings. Although one can be addicted to sugar, usually it is our diet and lifestyle choices, that are the major causes of our sweet tooth.

  1. Sugar causes increased transport of the amino acid, tryptophan, into the brain, where it is converted into serotonin, our feel-good brain chemical. This causes a temporary elation, followed by an immediate regression in mood.
  2. The release of cortisol during bouts of stress cause a roller-coaster of blood sugar highs and lows. To keep your energy up, you reach for the quickest and sweetest form of vitality—sugar.
  3. Sugar consumption can increase endorphin release, which has pain-relieving qualities. This is most notable during PMS, when women experience cramps and sugar cravings.
  4. An imbalance in gut bacteria can lead to an overgrowth of microbes, whose increased sugar requirements stimulate cravings.

Curb your cravings:

  • Consume a complete protein at every meal
  • Remove sweets from your kitchen and office to avoid temptation
  • Opt for 70% dark chocolate which has less sugar and more anti-oxidants
  • Stay hydrated, as dehydration materializes as food cravings
  • Get more sleep to reduce stress

 


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Did you know there are 5 types of PMS?

Ladies, that time of the month is never as pleasant as the commercials depict with women frolicking in a park or dancing in a tight dress. PMS can be miserable. So miserable that we take time off work and away from family and friends to nurse our monthly flow. We are told that PMS is normal—your mom had it, your sister has it, your grandma had it—and the only treatment is popping Advil and retreating from society.

Guess what?! PMS IS NOT NORMAL. PMS is a constellation of symptoms that tell us our hormones are imbalanced. Using you symptoms as the guide sheds light on your specific imbalance.

The 5 types of PMS are caused by different imbalances, all of which are treatable with dietary and lifestyle changes and supplementation.

Type A for Anxiety. Up to 80 % of women experience this type, characterized by hypersensitivity, mood swings, irritability, tension and crying easily. This type results from a relative drop in progesterone at the end of the cycle, which can also cause the period to start suddenly and contain heavy clots.

Type C for pmsproblemsCravings. Women with cravings (you know who you are!), usually crave chocolate or sweets and notice a dramatic, sometimes uncontrollable increase in appetite. This type, affecting 50% of women, is related to abnormal insulin levels and blood sugar. Headaches, fatigue, moodiness and irritability can also occur. Eating frequently and focusing on protein curbs those cravings by stabilizing excess insulin.

Type D for Depression. Depression, forgetfulness, insomnia, confusion, withdrawal and clumsiness characterize this PMS type. It is caused by relatively low levels of estrogen and serotonin—your feel-good brain chemical. Exercise is very important and eating phytoestrogens, such as fennel and flaxseed, can reduce your symptoms.

Type H for Hyper-hydration. Water retention causes swollen fingers and ankles, breast tenderness, bloating and weight gain. There are a few causes, including too much stress, impaired lymphatic flow and high serotonin. Alcohol and excess sodium should be avoided and potassium-rich foods, such as broccoli, avocados and bananas, should be consumed to reduce these pre-menstrual symptoms.

Type P for Pain: Pain can be a debilitating symptom of PMS, occurring in the joints, lower back, abdomen or head. Because this is caused by an increase in inflammatory chemicals, the nightshade vegetables, which exacerbate existing inflammation and include potatoes, peppers, eggplant and tomatoes, should be avoided. Consuming omega-3s, which are high in anti-inflammatory chemicals, can reduce symptom severity over time.

What if you have symptoms from each category?! This is common, whether you experience a combination of types with each period or it changes from month to month. This is because our diet and lifestyle dramatically affect our interconnected web of hormones and brain chemicals. The starting point is a always improving your diet and regulating lifestyle factors, such as stress. These modifications make a huge difference and with a few herbal and nutritional supplements, PMS is no longer your norm.

 


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Specialty Tests to Improve your Health Outcomes

Lab work is a staple in any comprehensive treatment program. Many tests can be performed through OHIP (B12, iron, glucose, etc), but many blood tests can be inconclusive or not show us the whole picture.

For example, the ranges for TSH (Thyroid stimulating hormone) and B12 are not adequatemedical_test_result on conventional blood tests. Many patients experience symptoms despite their lab results being in the “normal” range. In addition to interpreting these tests differently, there are many tests ordered through your naturopath that relay a better understanding of your health.

Food Sensitivity Test: By-far the most popular test! This quick, and simple pin-prick blood test, measures the amount of IgG antibodies that your body produces against 96 common foods. Unlike the skin-prick test that measures immediate food allergies (hives, swollen lips, difficulty breathing), this test measures a dCholesterol lab test reportelayed immune response to food that can cause bloating, gas, IBS & IBD, skin rashes like eczema & acne, headaches, fatigue, joint pain and impaired immunity.

Adrenal Stress Index: Canadians are under chronic stress, causing long-term release of cortisol. Cortisol has many negative impacts on the body,including insulin resistance, difficulties losing weight, mood imbalances, low libido, impaired immunity and fatigue. This test not only measures your cortisol rhythm throughout the day—Is it too high or too low in the case of burnout—but also the related hormones such as DHEA, progesterone and insulin, which are affected by its release. This test provides you with an accurate depiction of how stress is affecting your overall health.

Month-Long Female Hormone Panel: Menstrual irregularities, menopause and PMS are the result of an imbalance in female hormones. Simple blood tests provide only a snapshot during the month, being useful only if their is a gross abnormality. Also, blood tests of hormones do not accurately reflect the hormones that reach tissues and have a physiological effect. Salivary hormone testing is done for 11 days over an entire cycle, mapping out the absolute concentration and relative balance of the female hormones, estrogen and progesterone, FSH and LH.

Male Hormone Panel: Low libido, difficulties losing weight, and depression can be symptoms of testosterone and hormone imbalance. The hormones are also measured in the saliva, providing greater accuracy and they include testosterone, DHEA/S, Androstenedione, DHT and Estrogen.

*At least partially covered by most extended health benefits

**The results of most tests are reported within 3 weeks.

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