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Lactation Consultant Support

Although any form of chest feeding (feeding of a newborn whilst the parent holds them at their chest) fosters an emotional bonding between child and parent not offered by “traditional” methods of bottle feeding, consumption of breastmilk by newborns offers unparalleled benefits to child and “breast feeder”.

Benefits of breastmilk to newborns

Consumption of breastmilk offers a newborn child many health benefits, some extending into adulthood, including decreased risk of:

  • Cavities
  • Ear infections
  • Asthma
  • Eczema
  • Obesity
  • Type 2 diabetes mellitus
  • Many infections, including pneumonia, respiratory syncytial virus (RSV) and bacterial meningitis
  • Gastrointestinal symptoms (e.g., vomiting, diarrhea, and more serious conditions such as celiac disease, inflammatory bowel disease and necrotizing enterocolitis)
  • Sudden infant death syndrome (SIDS)
  • Childhood leukaemia
  • Cardiovascular disease in adulthood
  • In general, lower rate of hospitalization, and a tendency to better health compared to non-breastfed children

Benefits of breastfeeding to the breastfeeding parent

Breastfeeding also benefits the “breastfeeder”, including decreased rate of:

  • Breast cancer
  • Ovarian cancer
  • Type 2 diabetes mellitus
  • High blood pressure

Obstacles to breastfeeding

Although some are not able to breastfeed owing to use of medications that may be passed through breastmilk or economic obstacles (e.g., an employment situation that does not allow for effective breastfeeding), many who are able to breastfeed are discouraged from it by the challenges it presents, most of which (e.g., low milk supply) are soluble with the support of a lactation consultant.

Our goal at Toronto Centre for Naturopathic Medicine is that every parent who is able to breastfeed, and wishes to breastfeed, receives the support they need to be able to offer their newborn this incomparable source of nutrition (and parental bonding).

Can a lactation consultant help me?

Lactation consultants are healthcare professionals who are able to help you identify solutions for common challenges of breastfeeding, including:

  • Baby not gaining weight
  • Low milk supply
  • Baby refusing the breast
  • Difficulty with nursing positioning
  • Poor latch
  • Difficulty sucking
  • Tongue tie
  • Sore or cracked nipples
  • Plugged breast ducts and infection (e.g., mastitis)
  • Breast engorgement
  • Pumping for bottle feeding

When should I contact a lactation consultant?

Lactation consultants are most often consulted in the weeks following birth, by first time parents as they begin learn the various skills of parenting, but parents of any breastfeeding child who are facing these challenges may benefit from assessment by a lactation consultant.

In certain circumstances, an assessment pre-birth may have value. Certain breastfeeding challenges (e.g., nipple inversion) are most effectively addressed prior to beginning breastfeeding. If you are uncertain whether you may benefit from an an appointment with a lactation consultant, you may contact us to arrange a complimentary “Meet and Greet” appointment.

What are the qualifications of a lactation consultant?

Our lactation consultant, Laura Kent-Davidson, ND, IBLCE, in addition to her qualification as a licensed naturopathic doctor, is an International Board of Lactation Consultant Examiners (IBLCE) certified lactation consultant.

Training and certification by the IBLCE requires a candidate to complete:

  • 90 hours of classroom education including breastfeeding, nutrition and anatomy
  • 1000 hours of lactation-specific clinical experience
  • Successful completion of a certification examination
  • Completion of yearly continuing education requirements
  • Re-certification every five years

Lactation Consultant Services at Toronto Centre for Naturopathic Medicine

Lactation consultations at Toronto Centre for Naturopathic Medicine are offered by Laura Kent-Davidson, ND, IBLCE and may be conducted at your home or virtually. Initial lactation consultation appointments are 75 minutes in duration.

At your appointment you will:

  • Discuss your current breastfeeding concern
  • Review your health history and Intake Form
  • Assess your infant, including a thorough oral examination
  • Assess your feeding practices
  • Create a plan to address your breastfeeding concern, including planning follow-up consultations if necessary or desired

As a licensed naturopathic doctor, Laura may also review with you parental nutrition, your child’s sleep patterns and postpartum transition as, viewed through a holistic lens, are important variables potentially affecting lactation, breastfeeding and the postpartum experience in general.

A treatment plan from a naturopathic doctor offering lactation guidance may include (prescription of):

  • Specific lactation support strategies such as modifications in positioning of your baby or timing of feedings
  • Dietary recommendations
  • Nutritional supplements
  • Botanical (herbal) medicines
  • Lifestyle medicine (e.g., stress management strategies)
  • Physical medicine (e.g., use of compresses)
  • Referral to other healthcare professionals for support outside the scope of practice of a naturopathic doctor/lactation consultant

Are lactation consultant appointments covered by O.H.I.P.?

O.H.I.P. does not pay for lactation consultant appointments, but as a government-regulated healthcare profession, services offered by naturopathic doctors, including lactation consultations, are covered by most extended healthcare plans.

References

NHS. Benefits of breastfeeding [Internet]. England: National Health Service. [updated 2023; cited 2023 Jun 7]. Available from: https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding/benefits/

Cleveland Clinic. Benefits of breastfeeding [Internet]. Cleveland (US): Cleveland Clinic. [updated 2022; cited 2023 Jun 7]. Available from: https://my.clevelandclinic.org/health/articles/15274-benefits-of-breastfeeding

CDC. Breastfeeding benefits both baby and mom [Internet]. US: Centers for Disease Control and Prevention. [updated 2021; cited 2023 Jun 7]. Available from: https://www.cdc.gov/nccdphp/dnpao/features/breastfeeding-benefits/index.html#:~:text=Breastfeeding%20can%20reduce%20the%20mother’s,common%20among%20women%20who%20breastfeed.

ACOG. Barriers to breastfeeding: supporting initiation and continuation of breastfeeding [Internet]. US: The American College of Obstetricians and Gynecologists. [cited 2023 Jun 7]. Available from: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/02/barriers-to-breastfeeding-supporting-initiation-and-continuation-of-breastfeeding

Roasted Vegetable White Bean Salad

This is my all-time favourite dish to make and share. It generates a very large portion so is a great dish to add to any celebratory meal, such as Thanksgiving or any gathering!

The sweetness of the caramelized vegetables, with the freshness of the herb medley, the savoury and flavourful dressing and the tart pomegranate seeds is a symphony of flavours in your mouth. Thank you to my cooking hero Samin Nosrat for making this dish in her netflix series, Salt, Fat Acid and Heat and inspiring me to make this dish. My only contribution is that I added the pomegranate seeds and I think this little addition elevates this dish by adding a tart flavour to cut through the savoury vegetables.

Ingredients:

  • 1 bunch young carrots (rainbow if possible)
  • 1 small head cauliflower
  • 1 small head romanesco or broccoli
  • 1½ pounds Brussels sprouts, trimmed, outer leaves removed, and halved (quartered if very large)
  • 2 cups cooked white beans, such as gigante, butter, cannellini, or navy beans, liquid reserved
  • 4 ounces goat’s milk feta cheese
  • Extra virgin olive oil
  • Kosher or Sea Salt
  • 1 cup loosely packed cilantro leaves and tender stems
  • 1 cup loosely packed dill fronds, stems removed
  • 1/2 cup loosely packed mint leaves
  • Pomegranate arils
  • Red Wine Vinaigrette (recipe below)

Red Wine Vinaigrette Ingredients:

  • 1 tablespoon finely diced shallot
  • 2 tablespoons red wine vinegar
  • 6 tablespoons extra-virgin olive oil
  • Salt
  • Freshly ground black pepper

For the vegetables and salad:

  1. Place oven racks in lower middle and upper middle positions. Preheat oven to 425°F.
  2. Halve or quarter Brussels sprouts through the stems, then place in a large bowl. Toss with enough oil to coat, about 3 tablespoons. Season with salt and place in a single layer on a baking sheet.
  3. Place the carrots in the same large bowl and toss, adding more oil as needed to coat. Season with salt and place in a single layer on a second baking sheet.
  4. Lightly trim the root end of the cauliflower and romanesco (if using), then cut into 3/4-inch-thick slices through the root. Drizzle about 2 tablespoons oil onto another baking sheet and lay slices in a single layer, keeping cauliflower on one side of the pan and romanesco on the other side. Avoid overcrowding the vegetables—they should not touch. (If needed use another pan for overflow.)
  5. Place vegetables into oven and cook until tender and caramelized, about 26 to 30 minutes. Check on the vegetables after about 12 minutes. Rotate the pans and switch their positions to ensure even browning.
  6. When the roasted vegetables are brown on the outside and completely tender when pierced with a knife, remove them from the oven. Set aside to cool for a few minutes.
  7. Reserving the cooking liquid, drain beans and place into large bowl. Dress with 3 tablespoons vinaigrette and season with salt and 1 teaspoon za’atar. Add a little bean liquid to make it juicy. Taste and adjust dressing and seasoning as needed.
  8. To assemble salad, layer cauliflower, romanesco (if using), carrots, and Brussels sprouts on a large platter. then spoon beans over vegetables. Sprinkle with large crumbles of feta. In a medium bowl, lightly dress cilantro, dill, basil, and mint with 1 tablespoon or so of vinaigrette and salt. Place atop salad. Sprinkle with large crumbles of feta and pomegranate arils. Mix well and serve immediately.

Red Wine Vinaigrette Instructions:

In a small bowl or jar, let the shallot sit in the vinegar for 15 minutes, then add the olive oil, a generous pinch of salt, and a small pinch of pepper. Stir or shake to combine, then taste with one of the vegetables and adjust salt and acid as needed.

Enjoy this incredible dish with loved ones!

Cover and refrigerate leftovers for up to 3 days.

I hope you get a chance to make it!

Dr. Du La, ND

The Role of Confidence in Health, and How to Achieve It

Micheal Jordan may have character flaws, but self-doubt isn’t one of them.

One of our children has started to develop the habit of negative self-talk. We’re not exactly certain from where this habit has begun to form: maybe it’s a normal part of teen behaviour, that “this sucks” attitude; maybe it’s that our society frowns on displays of confidence as “cockiness”, and like most persons she doesn’t distinguish between a “felt confidence” and an attitude of cockiness; or maybe some other reason.  Although it was my concern as a parent that prompted this “research”, as a naturopath, I’ve noticed a disproportionate number of people (who consider engaging in positive self-talk corny) consistently, subconsciously, engage in negative self-talk.

Without judgment, it’s a shitty way to spend a life, always putting yourself down, and not being able to take pleasure in your achievements, and while as a parent it’s a mindset/pattern of thinking I want to “correct” in my daughter, as a naturopath, I’ve seen it repeatedly undermine patients success in achieving their health goals and quality of life.

With this in mind, I read the book: The Confident Mind: A Battle Tested Guide to Unshakeable Performance by Dr. Nate Zinsser, to learn how to teach the self-confidence that is the foundation for success.

This book is primarily directed at elite athletes, but the guidance can be generalized to anyone wishing for “peak performance”, or simply “success at achieving a goal” (including a potentially daunting lifestyle change).

To succeed in sport, career or behavioural change, it is essential to first win a “first victory” of actually believing victory is a possibility.

I am reminded of the career of Mike Tyson. At the start of his career he was thought to be unstoppable. At the pre-fight stare-down, even my teenaged self could see his opponents had already lost the fight: they felt no hope of victory, and seemed to be most focussed on survival at best.

Until he fought Buster Douglas, a 42 – 1 underdog. Douglas was a talented boxer and trained hard for the fight, but what separated him from Tyson’s earlier opponents was that his goal wasn’t survival, his goal was to be The Champ (his mother had died 23 days before the event, and the story goes that he had dedicated his performance to her). From the start, it was obvious his intention was to win, and when combining his intention with talent and hard work, he achieved the unimaginable!

The parallel I have noticed in patients when discussing losing weight, embarking on dietary change, starting an exercise program, etc. is that many’s expectation is not to succeed, but to “do their best”. I understand why a person with a busy life who may have been unsuccessful at this in the past may not feel confident committing to a health goal (and the ego risk associated with failure to follow through on a commitment), but now recognize the presence or absence of the confidence to “make it happen” as an important determinant of a patients’ ultimate success.

As Yoda said: “There is only do, or do not. There is not try.”

“The Glass is Half Full” Isn’t a Lie

One “error of perception” I’ve noticed that undermines peoples ability to think positively about their ability to succeed at any task is the feeling that they are being dishonest with themselves if they don’t focus on their shortcomings. That if they have unsuccessfully tried to change their eating habits in the past, to think of themselves as a person who can change their diet is a lie because the existing evidence does not support this belief.

But neither does it disqualify it.

They have had made successful changes in their lives (e.g., job transitions) and had failures (e.g., improving their eating habits). Both are valid experiences.

Steph Curry, considered at the time of this writing, the greatest shooter in basketball history, has a field goal percentage of 43.7%, meaning, statistically, he misses more shots that he makes. And yet, most would agree, he has every cause to be confident in his ability to shoot a basketball (to quote the man himself – “Every time I rise up, I have confidence that I’m going to make it”). Missing shots does mean you cannot hit shots.

To focus on your strengths and successes is no less honest than to focus on your weaknesses and failures. To view any challenge with optimism is no less honest than to view it with pessimism, but optimism increases your probability of success, and your self-esteem and happiness.

So, if you’re with me so far, I assume you’re interested in knowing: how  do I get to this place of confidence.

What, exactly, do we mean by confidence?

Good question.

When describing a confidence mindset in the context of changing health behaviours (and as a result, health outcomes), I am referring to starting the process of changing your lifestyle with the expectation that you will succeed.

If you think back to any challenge you’ve successfully met, it is very unlikely you entered into it expecting to fail. Even if you did not, at the time, perceive the presence of a “success mindset”, it was there. Any person that has completed a course of study has experienced “confidence”. If they didn’t enrol in a program planning to flunk out, then surprised themselves by succeeding, they were “confident” (expected to succeed)!

This mindset is achieved by practicing and gaining the skill to consistently think of yourself as a person who is competent, able to learn new skills and persevere through challenges, and recognizing the “evidence for competence” provided by past successes.

Dr. Zinsser organizes his exercises for increasing confidence into two main categories of action:

  1. Gaining confidence, and
  2. not losing confidence.

Below I’ve edited the recommendations in Dr. Zinsser’s book to those simply applicable to successfully changing lifestyle and achieving better health.

First: Building Your Confidence

The first step in focussing on the positive is to identify the positive. We have all experienced successes in the past, in order to “live in this positive place” we need to have ready access to our successes.

As a first step, take the time to sit down and list five occasions on which you had success in participating in activities that support your health, or even actions or experiences that support healthful decisions.

These successes do not have to be dramatic – simply examples of occasions on which you “did the right thing”, that you can bring your attention to when you doubt your ability to continue or succeed.

The time you stopped eating when you felt full, and enjoyed the feeling of “not being stuffed” after a meal.

The time you felt tired, but decided to go for a workout and felt great afterwards.

The time you went to bed early rather than watching another episode on Netflix and woke up the next morning ready to take on the day.

The time you were feeling lazy, but decided to go meet friends instead and were glad you did.

Take a moment to re-visit these successes briefly every morning before you start your day, and every evening when you lie down to sleep. Practice thinking of yourself as a person who meets their goals!

Once you begin your lifestyle change, conduct a daily “E-S-P (Effort-Success-Progress)” assessment.

Confidence is not a destination, it’s a process. Continue to support your confidence in your ability to succeed by bringing your attention to the positive, the successes of the day.

You worked out today. Great, sit with that and bask in the satisfaction of a goal met!

You avoided high-sugar, high-calorie foods. Visualize your slimmer, more active self moving through life!

You completed the bedtime skincare routine you used to be too tired to carry out. Imagine your healthy-skinned future self!

Spend some time daily becoming aware of how successful you are becoming in moving towards your goal.

Similar to E-S-P, but different acronym (I-P-R = Immediate Progress Review)

You ate your goal of vegetables today. Notice the absence of the fullness heavy meals cause!

You exercised today. Notice how you felt energetic until the end of the day!

You didn’t procrastinate today. Recognize and savour the progress you made today!

Use an Affirmation(s)

Affirmations were once the the object of mockery, but have been used for centuries in other cultures (in meditation, the practice of a “sankalpa” exactly describes the following exercise Dr. Zinsser includes in his book), and research into “thinking habits” has validated the idea that if a person predisposed to negative thinking practices positive thinking “with effort” consistently, with time they can develop the habit of positive thinking.

An effective affirmation has three considerations. It is:

  1. Positive
  2. In the present
  3. “Felt”

For example, a person wanting to increase their confidence may repeat:

  1. “I am confident” (as opposed to “I am not a loser” – the brain does not effectively distinguish between “I am” and I am not” statements)
  2. “I AM confident” (as opposed to “I will be confident” at some indeterminate time – I do not know the reason for this, but my own sense is that “you are already enough”, you are only using the affirmation to access what is already present in you)
  3. “Felt” – Do simply repeat the words without awareness. Take a moment to feel the (e.g.) confidence you are moving towards. Every person has a setting in which they feel confident: bring your imagination to a context in which you are confident and “feel” this as you repeat your affirmation.

I have always only used affirmations for qualities I have felt I have complete control over (e.g., “I am patient”), but importantly, research supports the use of affirmations for “wishes” as well. Don’t hesitate to use affirmations to increase your confidence in meeting more “nebulous” goals (e.g., “I am healthy”, “I am successful”).

Then: Protecting Your Confidence

As noted above, confidence is a process, not a destination.

Confidence is also not “absence of doubt”. It is a way of responding to doubt.

A batter in a slump needs to ensure a slump is a temporary setback, not the beginning of the end of their career.

Once you are in the routine of believing in yourself, it is important to not allow “failures” to erode your confidence.

An important understanding of “failures” is to recognize that they do not represent the whole of you or your progress. “Failures” are:

  1. Temporary. A missed shot is just a missed shot. You are starting over with your next shot. A day of poor eating is a day of poor eating, do better tomorrow.
  2. Limited. An unanswered question on an examination is not a failure, continue to the next question and answer that one. Not meditating today does not mean you can’t  meditate tomorrow.
  3. Not representative of you or the sum of your efforts. Raising your voice to your children does not mean you are  terrible person or an uncaring parent, calm yourself, apologize and try to be more patient in future. A missed workout doesn’t mean you are now fated to heart disease – go to the gym tomorrow.
  4. An opportunity to improve. Were you late for work because you thought the 8 o’clock train was early enough? Take the 7:45 train. Did you eat at McDonald’s because no healthy options are available near your workplace? Pack a healthy lunch moving forward. Identify the lesson, correct the action, move on.

Too many words, Doc

I know.

In a nutshell:

  1. To say a glass is half-full is an honest assessment. Don’t ignore your weaknesses, learn from them, but focus on your strengths.
  2. Identify successes consistently and bring your attention to them daily.
  3. Remind your self of your strengths and intentions daily using affirmations.
  4. Understand the limited nature of “failures”, use the lessons they offer, and let them go.
  5. Get out there and go for the life you want!

Living to 100: the Mystery Solved!

Full disclosure: this isn’t the revelation of a scientific discovery. More me organizing my thoughts after having had a small epiphany of sorts.

Over the years I’ve been asked the question: “How can I live to 100?” more than once (and once, “200”, by a particularly optimistic patient). The conversations that followed typically included questions about various “hacks” (fasting, ketogenic diet, etc.) and trending concepts (measurement of telomere length, autophagy, etc.), and I would attempt to mold the knowledge we have about these practices and ideas into a cohesive plan of action.

The main challenge, at least to my mind (I’m unsure whether patients recognized my struggle), was the nebulous nature of “living longer”.

As a general practice, one has to have a clear view of the “problem” before a clear solution can be created. “Living longer” (than a person would have otherwise) is kind of like “doing better”. Who can disagree with wanting to “do better”, but better than what?

The secret to human longevity resolved!

Last month I was listening to a conversation between a conventional medical doctor who researches longevity and another expert in some related field. He commented, with dismay, that conventional medicine focusses only on prolonging  life once a patient has a chronic disease.

But once a person has a chronic disease, they are typically (at least statistically), already on the road to a shorter life, it’s only a question of how much shorter (to say nothing of the quality of a long, but “disease symptom having” life)!

The bottom line is: the secret to longevity is to not develop a chronic disease!

On the face of it, this is obvious, but it does help (me) by creating a clear objective. While the scientific evidence for strategies for “lengthening life” is limited and not conclusive, there exists a vast, throughly researched body of evidence for preventing chronic disease.

And much of it is consistent with the what is known about the various measurements that are often associated with measuring lifespan (reducing telomere shortening, triggering autophagy, etc.)

Practically, the plan is similar, but now has more “direction”.

What are the practices we know that support longevity (i.e., prevent disease)?

The most important practices will surprise no one, and importantly are very “actionable”:

  1. Eat a the appropriate amount of nutritions food
  2. Engage in an appropriate amount of exercise
  3. Manage your stress
  4. Let your body recover with adequate, restful sleep
  5. If you are a smoker, stop smoking

(Also important, actionable, but potentially more complex: engage in healthy social relationships).

If it’s that simple, why don’t we all live, disease-free, to 100?

Frankly, because the devil’s in the details!

In my experience, broadly speaking, the two main reasons people don’t successfully change to a more healthful lifestyle are:

  1. They don’t (even) understand their goal
  2. Too much noise, not enough signal
  3. They’re not “ready”, and don’t know how to get to ready

“What are you even trying to do?”

(Similar to me), many people wanting/hoping to live longer do not actually want to live longer in years, they want to improve the quality (which coincidentally  will increase the number) of years they will live. No person dreams of living to 100, but bedridden and in pain beginning at age 50.

Too much noise!

Most persons, by the time they finish their formal education, will have learned how to calculate the angles of a triangle, but will never have been taught, in any meaningful way, what foods, and how much to eat in order to maintain good health.

They won’t know exercise guidelines or how to interpret them.

They won’t have learned any effective stress management strategies.

And they will not understand the value of sleep, or what an appropriate “bedtime” is for an adult (other than “when my show’s over”).

In spite of the volume of information and data available at out fingertips, most people either don’t have the time or the background education to turn the volumes of knowledge into an actionable plan.

That’s where we come in.

They don’t know how to get “ready”.

This has happened to me more times than I can recall over the course of my career: a person with the goal of losing weight makes and appointment and asks me to recommend a “new” diet, because the ones they have tried in the past haven’t worked.

The scientific literature demonstrates that all the “major” diets are effective to some extent (obviously some are “better” than others).

The problem each of these persons is trying to solve is not “finding a better diet”; it’s understanding why they have not been able to be consistent with the dietary changes they’ve attempted in the past. If they don’t understand and change these variables, it doesn’t matter which diet they attempt next. If your foot is a size 12, it doesn’t matter if the shoe you try on is a runner or dress shoe; if it’s a size 8 it won’t fit.

Change is a process. While finding “a good diet” is part of the process, what most persons actually (or, also) need to succeed, is guidance with:

  • Fostering the confidence to start the process (sometimes for the umteenth time) with a “success mindset” – planning and expecting success rather than another round of failure
  • Cultivating mindfulness around lifestyle so that every evening doesn’t end with the disappointment of “Well, I overate at every meal again today.”
  • Creating a “time management” plan to avoid ending every day “Well, I didn’t get to the gym again.”
  • Identifying and fostering strategies to be consistent – slowly transforming “new behaviours” into a lifestyle – easy practices, “hobbies” even, that are second nature and not requiring of discipline or sacrifice

We can help with this too.

And obviously, there are a myriad of specialized assessments that are available.

But that’s not what this post is about (but we can help with that too).

Anyway, those are my thoughts, “freestyle”, on this sunny afternoon, on how to increase longevity, and a few obstacles that explain why the simple is, for many, difficult to achieve.

Thanks for reading!

Everything You Need to Know About Light Therapy for Seasonal Affective Disorder (SAD)

The value of light therapy for treatment of Seasonal Affective Disorder (SAD) is well established1, 2, 3, but for those interested in  pursuing this approach, the obstacles are the time to determine which product will be potentially most effective, and how to implement use  to achieve a therapeutic effect.

The purpose of this post is not to contain “everything”, just everything you need to know to how to find a product that works for you, and how to use it effectively (that’s a disclaimer).

My interest in this topic is somewhat personal: as I age, I am becoming aware that during the winter, my mood changes. To describe my mood as “depressed” is a disservice to people experiencing depression. It’s more of a “joylessness” or “flatness” that I begin to notice after a few weeks of dark days (this post is prompted by the consistently gloomy autumn we’ve had this year).

On one hand, this is a part of life (my grandmother had the same experience – she simply accepted it and carried on).

On the other, as someone (Peter Beard, I think) remarked: “I wake up every morning because this is my one and only life” (or words to that effect, I’m paraphrasing from memory). Life is too short to let half the year(/your life) pass feeling flat.

What is the Relationship Between Light and Seasonal Affective Disorder (SAD)?

In a nutshell, the relationship between mood and light is thought to be rooted in our circadian rhythm (although the scientific support for this is at this time not robust2). Certainly, there does exist evidence that secretion of melatonin (a hormone secreted by our pineal gland) and  is disrupted in persons experiencing Seasonal Affective Disorder (SAD).3

The main roles of melatonin in our body are to regulate our sleepiness and wakefulness, and in sexual development.

Melatonin levels respond to the level of light in the environment: it is “turned off” by bright light.5 Melatonin levels are nearly undetectable during the day.5

How Does Light Therapy for Seasonal Affective Disorder (SAD) Work?

If the thought is that low levels of light during the winter, affect melatonin levels, affecting wakefulness and mood, the obvious course is to use a Light Therapy products during the day to replicate exposure to daytime light.

Specifically:

The guideline is 30 to 60 minutes daily of “white light” exposure, between September and April.1

If using a “blue light” product (which is required if melatonin suppression is the goal of Light Therapy use) 45  minutes of morning exposure is the prescription.1

You will notice that most products (at the time of this writing) deliver “white light”, and even the manufacturers customer service professionals appear not to know why a blue light mode is offered on certain devices (“Some people prefer the ‘softer’, blue light”) . Blue light (specifically light in the 446-477 nm wavelength) is required to suppress/regulate melatonin.6

Further, “full spectrum” light, although most closely mimicking natural light, does not offer any benefit with regard to mood, over white light.7

Importantly, although it is blue light specifically that supresses melatonin secretion, white light (full spectrum or otherwise) has proved to benefit mood for those experiencing Seasonal Affective Disorder (SAD).1

What Type of Light Therapy Product to Purchase

Light therapy products have become much more accessible over the years. Early in my practice I recall recommending these products, but the options were very limited, and the cost was in the 300 CAD range (and that’s in early-aughts dollars). Today, many products are available in the 50 to 100 CAD range (a dilemma of a different sort).

Based on the the research to date, important considerations when purchasing a Light Therapy product include:

  1. A blue light option (446-477 nm is the most potent wavelength region providing circadian input for regulating melatonin secretion–  I haven’t seen a product offering this level of detail in their listing; this is more of a “FYI” for if you do). Many products deliver only white light.
  2. 10’000 lux of brightness. Some products deliver less (e.g., 7500 lux).
  3. Ultraviolet (UV)-free light (all the products I have seen are UV light-free).

Other, more personal considerations may include:

  1. Ability to adjust light intensity. I have read reviews that describe certain products as delivering an uncomfortably bright light.
  2. Low glare. Most products I’ve seen appear to be “low glare”, but not all advertise this feature.
  3. Full spectrum light. Although full spectrum light confers no special benefit with regard to affecting mood when compared to white light, it offers what many consider a more pleasant  (natural light-mimicking) light.
  4. Some products may emit a “hum” which may be annoying to some.
  5. Use of LEDs as a light source to minimize maintenance.
  6. Portability. Most of these units are quite small, but some have more a “notebook” design that lends itself to transport for use at home and at work.

This is the product I’ve found that checks the important boxes (PureGuardian SPA50CA Light Therapy Lamp for those reading this after this link has expired).

Apparently it does emit a hum at higher intensity settings, and uses a timer that must be reset after 30 minutes maximum (i.e., you are not able to simply set it beside you and work for an entire afternoon), but those are shortcomings I can live with.

How to Implement a Light Therapy Strategy for Reducing Seasonal Affective Disorder (SAD) Symptoms

As written above, it is blue light specifically that suppresses melatonin. To reduce melatonin levels at waking, to increase alertness and “set” your circadian rhythm for the day, expose yourself to blue light, for 45 minutes at waking.

These devices suggest use at a distance of 6 to 24 inches (ideally seven inches), so depending on your morning routine, you will have to either wake earlier (and retire earlier the night before) to rest, read, meditate, etc. in bed for 45 minutes while using the device on your nightstand; or set it in your washroom vanity and/or kitchen counter as you begin your morning routine.

If you purchase a portable device, you can bring your unit to your workplace and position it on your desk, within 24 inches from where you sit (obviously this recommendation applies to those working in an office environment. These devices are not effective as “ambient light” – i.e., placed on the other side of the room as you go about your day). You can expose your self to bright (10’000 lux) white light for the day, but research suggests 30 to 60 minutes at least. My personal experience suggests between the hours of approximately 3:00 PM and 5:00 PM (the hours when in Toronto it begins to become perceptively darker), work well.

If you are considering a second, white light device for workplace use, here are two options that you might consider, a sleek, lower cost, option; and a slightly more expensive, adjustable light intensity option.

Lastly, there are obviously many other strategies that naturopathic medicine offers for management of Seasonal Affective Disorder (SAD), depression, anxiety and other mood disorders, that are outside the scope of a blog post, but if you are at the point you want to be aggressive about resolving your mood issues, get in touch.

Jonah Lusis, ND

References

  1. Thase ME. The new “blue light” intervention for seasonal affective disorder (SAD). Medscape [Internet]. [cited 2018 Dec 5]. Available at: https://www.medscape.org/viewarticle/550845?src=ppc_google_rsla_ed_ous_9mo&gclid=Cj0KCQiA6JjgBRDbARIsANfu58GtBXQyoQes-QHyfMws5tvmpq4UYR72kn4aVHKFIUgg_mPusQtl7q4aAnljEALw_wcB.
  2. Menculini G, Verdolini N, Murru A, Pacchiarotti I, Volpe U, Cervino A, et al. Depressive mood and circadian rhythms disturbances as outcomes of seasonal affective disorder treatment: A systematic review. J Affect Disord. 2018 Dec 1;241:608-626.
  3. Srinivasan V, Smits M, Spence W, Lowe AD, Kayumov L, Pandi-Perumal SR, et al. Melatonin in mood disorders. World J Biol Psychiatry. 2006;7(3):138-51.
  4. Sargis RM. An overview of the pineal gland: maintaining circadian rhythm. endocrine web [Internet]. [cited 2018 Dec 5]. Available at: https://www.endocrineweb.com/endocrinology/overview-pineal-gland.
  5. National Sleep Foundation [Internet]. Melatonin and sleep. [cited 2018 Dec 5]. Available at: https://www.sleepfoundation.org/sleep-topics/melatonin-and-sleep.
  6. Brainard GC, Hanifin JP, Greeson JM, Byrne BGlickman G, Gerner E, et al. Action spectrum for melatonin regulation in humans: evidence for a novel circadian photoreceptor. J Neurosci 2001 Aug 15;21(16):6405-12. Available at: http://www.jneurosci.org/content/21/16/6405.long.
  7. Lighting Research Centre [Internet]. How valid are the claims regarding full-spectrum lighting sources? [cited 2018 Dec 5]. Available at: https://www.lrc.rpi.edu/programs/nlpip/lightinganswers/fullspectrum/claims.asp.

 

 

Posted: 2018 Dec 6

SIBO (Small Intestine Bacterial Overgrowth) Breath Test

Is the SIBO breath test the right laboratory test for you?

In our experience, many persons having digestive symptoms receive a diagnosis of irritable bowel syndrome (IBS), but no particular guidance in identifying possible causes, or options for treatment other than symptom management (e.g., laxatives). SIBO (Small Intestinal Bacterial Overgrowth) breath testing may be the first step to understanding your digestive symptoms, and taking action at the “root cause” level.

Although this test is commonly referred to as SIBO breath testing, it may also be used to diagnose carbohydrate (sugar) malabsorption.

This laboratory test is used primarily to identify possible causes of:

  1. Unexplained irritable bowel syndrome (IBS) symptoms1 (abdominal pain, bloating, gas; diarrhea and/or constipation; mucous in stool2)
  2. Unexplained abdominal bloating3

Other health conditions associated with SIBO include:

  • Weight loss1
  • Anemia1
  • Malnutrition1
  • Hypothyroidism
  • Fibromyalgia1
  • Parkinson’s disease1

Specifically, this test diagnoses:

  1. Overgrowth of bacteria in the small intestine, or migration of bacteria from the large intestine to the small intestine3

  2. Carbohydrate (sugar) malabsorption3

How does SIBO breath testing work?

Breath testing relies on measurement of gases produced in the intestines that diffuse into the bloodstream and are ultimately expired through the lungs.3

Two of the main gases found in the breath, and produced exclusively by microbial fermentation of carbohydrates, are hydrogen and methane.3

Excess hydrogen and/or methane will be produced if excessive gut bacteria cause excessive fermentation of carbohydrates, either:

  1. In the small intestine because of small intestine bacterial overgrowth (SIBO)4, or
  2. Malabsorption of carbohydrates in the small intestine, allowing excessive carbohydrate to progress to the large intestine (colon), where there is excessive fermentation by bacteria.4

Basically: expired air is collected, and if it contains excessive hydrogen or methane, the only possible causes are excessive fermentation of carbohydrates by bacteria, either in the small or large intestine (depending on the timing of the higher than normal readings).

How does this SIBO breath test compare with other assessment options?

At Toronto-Centre for Naturopathic Medicine, we use BioHealth Laboratory’s test for SIBO breath testing, which is the most comprehensive option available to naturopathic doctors in Ontario.

The BioHealth Laboratory test:

  1. Measures both expired hydrogen and methane, and
  2. Offers testing using any combination of lactulose, glucose and fructose as test substrates.

These are important considerations, as:

  • 15% or more persons will produce methane rather than hydrogen   with microbial fermentation of carbohydrates. Tests measuring only hydrogen may result in a “false-normal” result for these persons.5
  •  Although measuring glucose fermentation alone is more sensitive (i.e., less likely to miss a diagnosis) than measuring lactulose fermentation alone in assessment of SIBO4, measuring both offers the most accurate assessment of gut bacteria status. Glucose is completely absorbed in the first section of the small intestine4, lactulose is absorbed throughout the small intestine, including the later portion of the small intestine6 and large intestine.Measurement of both allows for the most sensitive assessment of SIBO the first section of the small intestine; (slightly less sensitive) assessment of the later portion of the small intestine; and carbohydrate malabsorption resulting in excessive fermentation in the large intestine. 
  • Fructose malabsorption, although poorly understood as related to digestive symptoms, has been demonstrated to relate to increased severity of IBS symptoms.1

Importantly, breath testing is more reliable for “ruling in” SIBO than “ruling out” SIBO – if breath testing demonstrates you have SIBO, you almost certainly do; if breath testing suggests you do not, you probably do not, but be open to the possibility the test is incorrect.4

Other methods for assessing possible SIBO are:

  1. Bacterial culture – the most direct method, considered by some to be the “gold standard” (other experts are of the opinion no “gold standard” exists for diagnosis of SIBO4), but inconvenient to the patient, and prone to “false-normal” (i.e., incorrectly “ruling out” SIBO) results and contamination in the sampling process1, 4
  2. Urine organic acids testing (OAT) – sometimes suggested as an assessment option, but not diagnostic for SIBO7
  3. Stool analysis – sometimes suggested as an assessment option, but not diagnostic for SIBO7

How can you ensure the most accurate result possible?

Different laboratories suggest different (or no) guidelines for preparing for breath testing, but according to guidelines established in the 2017 Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus statement3, in order ensure the most accurate result possible:

  1. Antibiotics should be avoided for four weeks prior to breath testing.
  2. (If possible), promotility drugs and laxatives should be stopped at least one week prior to breath testing.
  3. Fermentable foods such as complex carbohydrates should be avoided on the day prior to breath testing.
  4. A fasting period  of 8 to 12 hours prior to breath testing.
  5. Smoking should be avoided on the day of breath testing.
  6. Physical activity should be limited during breath testing.
  7. Discontinuation of proton pump inhibitors prior to breath testing is not necessary.

What is the procedure for SIBO breath testing?

This test is conducted at home with a provided test kit.

  1. Beginning 24-hours before beginning the testing procedure, the specified diet must be followed.
  2. Beginning 12-hours before  beginning the testing procedure, the patient must fast.
  3. A baseline breath sample is collected.
  4. The glucose, lactulose or fructose mixture is consumed.
  5. Breath samples are collected every 15-minutes following mixture consumption until all 9 to 12 vials are filled (135 to 180 minutes, depending on test conducted).

In a nutshell:

  1. Consider this laboratory assessment if you have been diagnosed with IBS, or have digestive symptoms, with no identifiable cause.
  2. Measurement of both hydrogen and methane (as opposed to hydrogen only) allows for the  most accurate assessment of SIBO and carbohydrate malabsorption.
  3. Hydrogen/methane breath test using lactulose-only as a test mixture is more affordable (compared to lactulose and glucose test mixtures), and although slightly less sensitive, more reliably assesses the entire length of the small intestine.
  4. Testing for fructose malabsorption may be considered if suffering from severe IBS symptoms.
  5. This test is non-invasive, conducted at home, and requires up to three hours to complete.

Jonah Lusis, ND

References

  1. Simrén M, Stotzer PO. Use and abuse of hydrogen breath tests. Gut. 2006;55(3):297-303. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1856094/.
  2. Mayo Clinic [Internet]. Irritable bowel syndrome. [cited 2018 Nov 23]. Available at: https://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/symptoms-causes/syc-20360016.
  3. Rezaie A, Buresi M, Lembo A et al. Hydrogen and methane-based breath testing in gastrointestinal disorders: the North American consensus. Am J Gastroenterol. 2017;112(5):775-784. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418558/.
  4. Ghoshal UC. How to interpret hydrogen breath tests. J Neurogastroenterol Motil. 2011;17(3):312-7. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3155069/.
  5. deLacy Costello BP, Ledochowski M, Ratcliffe NM. The importance of methane breath testing: a review. J Breath Res. 2013 Jun;7(2):024001. doin:10.1088/1752-7155/7/2/024001.
  6. BioHealth Laboratory [Internet]. Small intestinal bacterial overgrowth (SIBO) breath testing.  [cited 2018 Nov 23]. Available at: https://www.biohealthlab.com/test-menu/sibo/.
  7. Siebecker A, Sandburg-Lewis S. SIBO: the finer points of diagnosis, test interpretation, and treatment. Naturopathic Doctor News and Review [Internet]. 2014 Jan 7 [cited 2018 Nov 23]. Available at: https://ndnr.com/gastrointestinal/sibo/.

 

 

Posted: 2018 Nov 23

Hangover Prevention – Because We’re There for You

It’s holiday party season, and with that, for many, holiday “over-drinking season” (that’s a discrete was of writing hangover).

There are a number of factors that appear to contribute to the symptoms experienced in a hangover: inflammation, oxidative stress and alcohol-induced nutrient deficiency specifically, that suggest that certain natural medicines may be effective “hangover cures”.

Here are a few “clinically proven” (by us) solutions to not feeling awful the day after celebrating.

The Affordable, Easy to Source, Hangover Preventing Vitamin/mineral Cocktail

About 12 years ago at a course on nutrition for conventional medical doctors, the discussion at one point took a turn to hangover prevention. The speaker, well-respected nutrition authority Aileen Burford-Mason, PhD shared her personal hangover prevention recipe: magnesium, zinc and B-complex.

I don’t recall her precise explanation for the how/why of this recipe: the magnesium I expect as a muscle relaxant to reduce the “clenched”/poorly relaxed sleep many have after excess alcohol ingestion; the B-complex because folate (vitamin B9) levels are adversely affected by heavy alcohol intake; and the zinc I assume because it is commonly deficient in those with a history of heavy alcohol use (but I’m not sure the role this plays in the occasional hangover haver).

Anyway, this was my “go-to” for many years, and I found it very effective. It prevents headaches, which I find the most unpleasant symptom of a hangover, as well as the muscle and jaw tension I am prone to experience.

I have found that although I feel quite well the morning after using this recipe, I am aware that my sleep is still of a very “light” quality, and I still need for a nap after a late night.

When I do this, my specific recipe is:

  1. Magnesium – 150 mg
  2. Zinc – 15 mg
  3. B-Complex – the amount of the product that results in consumption of 1000 mcg of vitamin B12
  4. Water – as much as I can remember to drink

I take this combination at the start of the evening, before bed (I leave the products on my night-table with a glass of water before leaving the house – this is how a 45-year old parties), and in the morning on waking.

The above combination will supply you for 20 to 30 nights out.

PartySmart®

PartySmart® claims to help your liver metabolize alcohol, speeding the removal of acetaldehyde from your system.

I have used PartySmart® several times over the past year, favouring it over the above cocktail primarily for it’s convenience. My experience has been that the results are similar: no hangover symptoms, but tiredness as the day progresses.

Room for Improvement!

In writing this post, I thought I might see what else is out there.

Apart from the usual: drink water, eat a heavy meal on waking, etc., what struck me was that neither of our above approaches really addresses what appear to be the most commonly accepted conventional explanation for hangover symptoms: inflammation and oxidative stress1.

To rectify this, I might add to either of the above protocols:

  1. Curcumin – if not the, then one of the most potent natural anti-inflammatories. Importantly, curcumin is poorly absorbed unless it is combined with black pepper or processed (e.g., Theracurmin™). 
  2. Antioxidants – Antioxidant Synergy (manufactured by AOR) is a nice, well-costed option containing both fat- and water-soluble antioxidants for distribution through-out the system, including N-Acetyl-L-cysteine (NAC), which crosses the blood-brain barrier for action in the brain.

Actually Clinically Proven in a Clinical Trial (as opposed to by carousing TCNMers) Hangover Prevention

I can’t believe researchers spend money on this, but a quick PubMed search revealed that they do!

The most compelling study I read demonstrated that an extract of Opuntia ficus indica (Barbary fig) was effective in reducing hangover symptoms2. Key findings were that risk of “severe hangover” were reduced by half, and notably inflammation (as measured by c-reactive protein) was 40% higher in subjects using placebo.

Unfortunately, I’ve never noticed a Barbary fig extract on the health store shelf (but in fairness, I’ve never really looked for one, so presumably it’s out there, if you do).

A Freebie: Making an Ass of Yourself Prevention

It’s all well and good to not have hangover the day after an office party, but you’re not going to be feeling well long if the night before you told your boss what you really think of them.

LivCo® is a natural medicine that we typically use in the context of metabolic detoxification protocols.

We learned of this application for LivCo® from a colleague of ours who recommends it for “industry types” who in the course of their work are required to attend frequent, boozy events, but by unfortunate coincidence, also need to stay sharp and tactful throughout.

Again, two tablets a few hours before, two tablets at the start of the evening, help one maintain a clear had with alcohol use.

Two more tablets at the end of the evening, and again the following morning can also reduce the probability of waking with a hangover, likely by a similar mechanism to PartySmart®.

As the botanical medicines in this product supports liver metabolism of chemicals, those using pharmaceutical medications should not use LivCo® without professional supervision.

Finally, and most importantly, the most effective method of preventing a hangover is drinking moderately (and always responsibly).

Happy holiday party season!

Jonah Lusis, ND

References

  1. Min JALee KKi DJ.The application of minerals in managing alcohol hangover: a preliminary review. Curr Drug Abuse Rev. 2010 Jun;3(2):110-5. 
  2. Wiese J, McPherson S, Odden MC, Shlipak MG.Effect of Opuntia ficus indica on symptoms of the alcohol hangover. Arch Intern Med. 2004 Jun 28;164(12):1334-40.

Posted: 2018 November 8

To Flu Vaccine, or Not Flu Vaccine – 2018 Edition

The flu vaccine is “released” annually in October, and with it, begins our season of answering the question: “Should I get the flu vaccine?”.

As naturopathic doctors, prescribing the flu vaccine, or advising against it lies outside out scope of practice.

We can however help you to make an informed decision by helping you understand what the most current research demonstrates with regards to flu vaccination decision factors.

We wrote a blog post on this a couple off years ago, but the research has been updated with the findings of more recent flu seasons, and here’s the what we know about the usefulness of the flu vaccine to date, and other relevant statistics, to date.

Statistically, your risk of contracting the flu is approximately 0.06% (but likely higher).

There are 23’000 laboratory confirmed cases of flu in Canada yearly1. The actual number of flu cases is likely higher, as many who contact the flu seek healthcare.

Assuming there are 36.95 million people in Canada, that’s simple math.

In the opinion of researchers, the flu vaccine isn’t particularly effective, but you be the judge.

These numbers are the most recent I could find, were from Cochrane’s 2018 February review of flu vaccine research.

Cochrane is a highly-respected organization that conducts research reviews (essentially gathering all the research available on a topic, removing biased or poor-quality studies, and using sophisticated mathematical tools to distil all the research findings into a “final word”).

According to the Cochrane review of research, to prevent one case of flu using “inactivated” vaccine (such as is used in Ontario):

  • 71 healthy adults need to be vaccinated2
  • 7 healthy children need to be vaccinated with a live attenuated vaccine3
  • 5 healthy children need to be vaccinated with an inactivated vaccine3
  • 30 older adults need to be vaccinated4

Flu vaccination reduces rates of hospitalization and absenteeism modestly.

  • Healthy adults who have received the flu vaccine are hospitalized 0.6% less often than those who have not2
  • Having the vaccine reduced missed work days by 0.042 (assuming a work day is eight hours, this works out to your working an extra 19.2 minutes each winter)

The flu vaccine may have risks that are not well understood.

We can’t make this decision for you, but are fairly comfortable advising that if you are concerned about contracting the flu, you need to do more than only flu vaccination.

Jonah Lusis, ND

References

  1. Ministry of Health and Long-Term Care. 2018/2019 Universal Influenza Immunization Program: Health Care Provider Q & A: General information [Internet]. [Cited 2018 Nov 1]. Available at: http://www.health.gov.on.ca/en/pro/programs/publichealth/flu/uiip/docs/flu_uiip_HCP_QA_2018-19.pdf.

  2. Demicheli V, Jefferson T, Ferroni E, Rivetti A, Di Pietrantonj C.

    Vaccines for preventing influenza in healthy adults. Cochrane Database of Systematic Reviews [Internet]. 2018 Feb 1 [cited 2018 Nov 1]. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001269.pub6/abstract.

  3. Jefferson T, Rivetti A, Di Pietrantonj C, Demicheli V.

    Vaccines for preventing influenza in healthy children. Cochrane Database of Systematic Reviews [Internet]. 2018 Feb 1 [cited 2018 Nov 1]. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001269.pub6/abstract.

  4. Demicheli V, Jefferson T, Di Pietrantonj C, Ferroni E, Thorning S, Thomas RE, Rivetti A. Vaccines for preventing influenza in the elderly. Cochrane Database of Systematic Reviews [Internet]. 2018 Feb 1 [cited 2018 Nov 1]. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001269.pub6/abstract.
  5. Cunningham AS. Official doubletalk hides serious problems with flu shot safety and effectiveness [Internet]. BMJ. 2018 Jan 9 [cited 2018 Nov 1]. Available at: https://www.bmj.com/content/360/bmj.k15/rapid-responses.

 

Posted: 2018 November 1

Bowen Therapy – Addressing the Missing Piece in Pain Treatments

This post is the outcome of being asked repeatedly how Bowen Therapy works, either by patients skeptical of gentle pressure effectively reducing symptoms of chronic pain, or shocked by the fact that gentle pressure successfully relieved their chronic pain where more aggressive treatments did not.

It draws primarily on a really great article on the concept of “central sensitization” as a cause for chronic pain by Paul Ingrham, referenced below.

Presently, dominant pain theory, and as a result, almost all pain treatments, focus on the tissue affected by injury/having pain (e.g., the joints in a person having arthritis, the neck of a person having whiplash), but ignore the role the brain plays in the experience of pain.

Although the impetus for pain occurs in the tissues (e.g., touching a hot pan), pain itself is experienced because your brain is “telling you” there is a “danger” at your hand (“Move your hand!”).

Central sensitization is not a theory, it is a physiological fact, operating by a known mechanism (neuroplasticity), explaining the way in which chronic pain modifies your brain and spinal cord in such way that it begins to signal “danger”, in the form of pain, inappropriately.

Basically, chronic pain “teaches” your brain that danger is a constant presence. It responds by giving you a constant “be gentle/careful” signal in the form of pain.

Central sensitization is the mechanism by which:

  • Pain may remain long after the tissue has recovered from the original injury (e.g., a person may experience muscle aches years after an auto collision).
  • Relatively minor pains may develop into a state of chronic pain (e.g., the development of chronic muscle aching, without any identifiable trauma).
  • Persons may experience pain more intensely than the stimulus suggests they should (e.g., the pain fibromyalgia sufferers experience from gentle pressure; persons having relatively minor joint damage experiencing debilitating joint pains).

How “Brain Pain” is Treated

As I wrote above, almost all pain treatments focus on the tissue where the pain is felt – anti-inflammatories for inflammation at the joints, chiropractic manipulation for misalignment of the spine, etc.

Based on what is known, the general guidelines for treating centralized pain are:

  1. Rule-out, or if present, address trauma at the painful tissue (i.e., if you have a broken bone, the brain is correctly reporting a threat – it must be addressed before the pain can subside).
  2. Minimize aggravation of the pained area (including aggressive treatments) which may reinforce the brain’s assessment of threat.
  3. Re-train your brain to understand that stimulation of the tissue in question is not a danger by “… exposing yourself to the pain, gently and cautiously challenging the body, probably mainly with activity and exercises in a baby-steps way. Other kinds of stimulation are potentially useful as well …”
  4. Being “kind” to your nervous system – essentially manage stress and allow the nervous system to be in a state that it is able to respond to stimuli calmly rather than “freaking out” at every trigger.
  5. Increase “plasticity” of the brain to foster “re-training” of the central nervous system out of it’s “pain habit”.

Bowen Therapy is a method of “gently and cautiously challenging the body”.

Although when Tom Bowen developed Bowen Therapy in the 1950’s, the concepts of central sensitization of pain and neuroplasticity did not yet exist, Bowen Therapy treatments and self-care he recommended to support treatments, reflects closely what is known about treatment of centralized pain today.

Bowen Therapy treatments are comprised of gentle pressure challenging muscles in areas of pain, followed by pauses integrated into the treatments to allow the brain to become comfortable with and understand that it is “safe” – no harm will occur from stimulus to the area.

The after-care recommendations are to be gentle with your body – engaging in gentle motion (e.g., walking), but avoiding strenuous activity (e.g, challenging exercise, aggressive treatments).

To further support Bowen Therapy treatments, based on what we now know about centralized pain, I might include meditation and intermittent fasting in a patients treatment plan.

You can learn more about Bowen Therapy, including research and more case report findings in treatment of a wide range of health conditions here.

References

Ingraham P. Central sensitization in chronic pain: pain itself can change how pain works, resulting in more pain with less provocation [Internet]. PainScience. Updated 2018 Sep [cited 2018 Oct 10]. Available at: https://www.painscience.com/articles/central-sensitization.php.

Sibille K, Bartsch F, Reddy D, Fillingim R, Keil A. Increasing neuroplasticity to bolster chronic pain treatment: a role for intermittent fasting and glucose administration? The journal of pain : official journal of the American Pain Society. 2016;17(3):275-281. doi:10.1016/j.jpain.2015.11.002.

– Jonah Lusis, ND

 

Posted: 2018 Oct 10

Bowen Therapy – A Case Report of Successful Treatment of Migraine Headaches

I’m writing this post to share some research I stumbled across in the course of my day-to-day work, researching treatments for patients having range of health concerns, in this case migraine headaches.

I won’t spend a lot of time here offering background into the nature of migraine headaches: if you suffer from migraine headaches, and you’re reading this post because you’re looking for solutions, then you likely know as much as you need to regarding migraines:

  1. The cause of migraine headaches is poorly understood.
  2. They suck.
  3. Success of conventional treatments is inconsistent.

The below is a published case report – basically a detailed record of one patient’s experience of treatment for their migraine headaches using Bowen Therapy (sometimes also called “Bowen Technique“, or BowenWork, among other descriptions).

If you want to read the report in detail, you can find it here.

The Patient

In this case report, the patient was a 66-year old female who had been having severe (symptoms including vomiting) migraine headaches several times weekly since approximately nine years of age.

She had also sustained severe neck, jaw and temporomandibular joint (TMJ) injuries in two separate automobile accidents.

Additional diagnoses of pain causing conditions included thoracic outlet syndrome (TOS) and degenerative disc changes.

Baseline migraine headache and neck pain levels

The patient was suffering migraine headaches; three to four times weekly; and intense chronic neck pain.

The pain was of an intensity that use of 10 to 12 Ibuprofen 200 mg tablets also necessitated, additionally, use of ice compresses and rest in a dark room until symptoms abated.

Her sleep was disrupted by migraine pain most nights.

On a scale of 0-6, with a rating of “6” representing “As bad as it could be”, she rated:

  1. Migraine = 6
  2. Neck pain = 6
  3. Activity limitation (unable to drive, socialize, etc.) = 5
  4. Well-being = 5

Bowen Therapy treatment process

The patient tracked their progress using the Measure Yourself Medical Outcome Profile version 2 (MYMOP2).

She used no other migraine headache treatment over the course of the study.

Three, once-weekly treatments were administered, and an assessment made, in order to determine if continued treatment was warranted/desired.

Mild improvement was observed after three treatments, and the decision was made to continue treatment.

Subsequent treatments were 45 to 60 minutes in duration, and scheduled every one to two weeks. Each treatment protocol was determined by patient feedback, with protocol combinations reflecting symptoms present at the start of each appointment.

The end-point of treatment was determined to be when the patient reported no occurrence of migraine headaches or neck pain for two consecutive sessions (i.e., two to four weeks in total).

Migraine headache and neck pain outcomes

The treatment end-point of two consecutive sessions without migraine headaches or neck pain after 14 treatments, completed over a period of approximately four months.

Migraine headaches were first absent after four treatments.

Neck pain decreased in a relatively linear pattern between treatments one and nine, after which it was reported as absent for the first time.

After treatment 10 neck pain returned following a severe allergic reaction, but resolved after two more treatments.

At treatment 14, the patient reported not having experienced migraine headaches or neck pain for two consecutive treatments.

At a follow-up appointment 10 months later, the patient reported no  episodes of migraine headaches or neck pain, and no new symptoms.

You can learn more about Bowen Therapy, including research and more case report findings in treatment of a wide range of health conditions here.

References

Gustafson S. Bowenwork for migraine relief: a case report. Int J Ther Massage Bodywork. 2016 Mar;9(1):19-28.

– Jonah Lusis, ND

 

Posted: 2018 Oct 9

 

 

 

 

 

Vitamin C – More than you care to know about it!

Recently, a patient asked me about a specific vitamin C product, basically whether it was worth paying a premium for.

In order to offer them the most accurate answer I could, I decided to confirm a few facts before replying, and ended up going down bit of a rabbit hole.

Vitamin C (ascorbic acid) is a an often over-looked (probably owing to it’s ubiquitous nature), but very valuable nutrient, protecting against heart disease and cancer; and supporting immune system activity and eye health, but where we use it most is in recovery from tissue healing (e.g., disc injury, sports injuries, etc.).

How much vitamin C should I take daily?

At this writing, the recommended daily allowance (RDA) for vitamin C is 60 mg daily, an amount that can be consumed by eating a single orange.

That said, experts disagree that this an optimal daily intake. Most vitamin C supplements offer 1000 mg per dose, and in the recent past, recommendations of 5000 or 6000 mg daily were not unusual.

For optimal vitamin C levels, research demonstrates that complete plasma (“blood”) saturation (i.e., the blood is as full as it can be) of vitamin C occurs at doses of 1000 mg daily.

White blood cells (i.e., cells of the immune system) were vitamin C saturated at even lower doses of 100 mg daily.

Should I take my vitamin C all at once?

No. Much of the vitamin C taken in a 1000 mg  capsule will be excreted in the urine.

At doses of 100 mg, no vitamin C is excreted in the urine (i.e., your body “keeps”, and presumably uses, it all).

At doses of 500 mg, bioavailability (i.e., the amount that enters the blood)  begins to decline.

This suggests, in order to not “waste” your vitamin C supplement, you should separate your intake into doses of less than 500 mg.

Importantly, slow-release vitamin C, which theoretically would allow for more complete absorption of higher doses of vitamin C, resulted in 50% lower absorption of 1000 mg of vitamin C in at least one study.

Ultimately, after at least one month of supplementation, users of both slow-release and regular vitamin C had equal blood vitamin C levels, but clearly, added cost for “slow-releasing” is not warranted.

How about “buffered” vitamin C?

Persons finding they experience digestive upset when using vitamin C are often directed to use “buffered” vitamin C products – mineral salts of ascorbic acid (e.g., calcium ascorbate), which are less acidic, and therefore thought to be less” irritating”.

There is little scientific support for this assertion.

Importantly, at the 1000 mg discussed above, the common digestive side effect of diarrhea, which may be mistakenly attributed to the acidic nature of vitamin C, is unlikely to occur.

How about vitamin C products combining bioflavenoids?

Bioflavenoids are plant chemicals that act as antioxidants, and are reputed to improve absorption of vitamin C.

Although they do add value to a product that is used for the purpose of antioxidant action, the research does not support that the vitamin C absorption of that product will be increased.

Sum it up, Egghead!

Vitamin C, take:

  • 1000 mg daily
  • In doses of approximately 400 mg (although practically, 500 mg is likely the closest dose you will be able to source)
  • Theoretically, having vitamin C with food may increase bioavailability (decrease “waste”)
  • Slow-release capsules, and bioflavenoids-added formulas do not improve vitamin C absorption

References

Zelman KM. Benefits of vitamin C [Internet]. WebMD. [cited 2018 Sep 14]. Available at: https://www.webmd.com/diet/features/the-benefits-of-vitamin-c#1.

Vitamin C [Internet]. Government of Canada. [cited 2018 Sep 14]. Available at: https://www.canada.ca/en/health-canada/services/nutrients/vitamin-c.html.

Oranges, raw, Florida, nutrition facts and calories [Internet]. SelfNutritionData. [cited 2018 Sep 14]. Available at: https://nutritiondata.self.com/facts/fruits-and-fruit-juices/1969/2.

Levine M, Conrey-Cantilena C, Yank Y, Welch RW, Washko PW, Dhariwal KR et al. Vitamin C pharmacokinetics in healthy volunteers: evidence for a recommended dietary allowance. Proc Natl Acad Sci USA [Internet]. 1996 Apr 16 [cited 2018 Sep 14];93(8):3704–3709. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC39676/.

Oregon State University. Linus Pauling Institute [Internet]. Supplemental forms. [cited 2018 Sep 14]. Available at: https://lpi.oregonstate.edu/mic/vitamins/vitamin-C/supplemental-forms.

– Jonah Lusis, ND

 

Posted: 2018 Sep 14

Helping Children Sleep Naturally

A frequent contributor to our friend Joy’s site, Du recently contributed an article on a vexing topic for many parents: getting young children to sleep.

Read, learn and enjoy it here!

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