Tag Archives: naturopathic doctor

SIBO (Small Intestine Bacterial Overgrowth) Breath Test

Toronto Naturopathic Doctors - SIBO 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

Toronto naturopathic doctors

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

Toronto Naturopathic Doctor

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:

  • 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

Toronto naturopathic doctors - pain

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

Toronto naturopathic doctors - migraine

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!

Toronto naturopathic doctors

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

Why Everyone Should Write a Love Letter To Themselves

Toronto Naturopathic Doctor

This past March, on the occasion of International Women’s Day, Du posted on Instagram a “love letter to herself”.

Our friend Joy loved it, and asked Du to contribute an article at her site on how a person can complete this very important writing exercise for themselves.

Here it is!

Natural Labour Induction + Augmentation | $175

Using natural medicines and treatments to induce, or augment a slowly progressing labour, is an effective means to potentially avoid cesarean birth (c-section), and experience less pain than in a Pitocin® (synthetic oxytocin)-induced labour. Continue reading Natural Labour Induction + Augmentation | $175

Birth Control: Hormones Redefined

Toronto Naturopathic Doctor

So many years ago, in 2005, Du wrote an in-depth examination of oral contraceptives (“birth control pills”) in the now out-of-publication “Naturopathic Medicine Today”.

Most of the information is still relevant today – but also an interesting archive of conventional approaches to birth control in a decade ago (mostly unchanged).

Read it below: