Adaptogens That I Use In My Practice

The term adaptogen is a term used by those who practice botanical medicine to describe herbs that help the body to adapt to physical and mental stress. Depending on how they are used, they may help with fatigue, certain hormone imbalances, blood sugar control, supporting the immune system, anxiety, depression, sleep and more. Because each patient case is unique, I carefully select the herbs that I use based on a thorough assessment of my patients. Below are three adaptogens that I often use in my practice.

Ashwagandha 

This herb is a great one for some of my stressed out and anxious patients. It has a role to play in supporting healthy thyroid function and balancing cortisol and testosterone levels. There are a number of studies on ashwagandha that demonstrate its ability to help with mental health, insomnia and fatigue. 

Siberian Ginseng 

Siberian ginseng is different from panax ginseng. It boosts energy without having an overstimulating effect. I consider this herb when I have a patient who feels burnt out and needs help with focus and improving their cognitive health. It can be a great one for students and busy professionals.

Rhodiola 

Rhodiola is a herb that I tend to use in some of my depressed patients. It can help improve mood, calm down anxiety and reduce fatigue. It can be beneficial in some of my patients who are struggling with menopause symptoms.

These adaptogens can interact with some medications and some medical conditions so you should consult with a qualified naturopathic doctor to help you choose the best adaptogen and dosage for you. 

Why It's Hard To Change Our Diets (And What To Do About It)

“I know what I should be eating but I can’t motivate myself to do it!” This is a common complaint I hear from patients. 

I want to first start off by reminding anyone who struggles with this to go easy on themselves. Food is a great source of comfort to people and carbohydrates and fats are fuels that our bodies are wired to gravitate towards. 

There are a number of underlying factors that could be contributing to this struggle. Below are just a few. 

Your Relationship With Food Needs Help  

If you constantly feel like you are trying and failing with some sort of weight loss diet (keto, paleo, sugar free etc.) the root issue could be that you have a negative relationship with food and body image. This could trap you in a perpetual state of hating your body, placing challenging demands on yourself to restrict food, feeling overwhelmed and eventually giving up on your diet plan. If this is the case, we need to work on healing this relationship with food and the body - something I love helping patients with.  

You Need Support With Anxiety Or Depression 

It’s hard to make food choices that nourish our bodies when our mental health is not in a great place. When we feel anxious, worried or down, we tend to want something that gives us a quick boost in mood. Foods higher in sugar, fat and salt can trigger more of a reward response in our brains - especially if we associate these types of foods with happier times. The root of the issue here may be that underlying anxiety, stress or depression is not being dealt with. Cravings may be a sign that your body needs some support with mental health - a topic that I’m passionate about.  

You’re Burnt Out 

When you’re depleted of energy and exhausted, the thought of preparing home cooked foods or even grocery shopping can be overwhelming. If you wish you could eat more fresh or home cooked foods but can’t muster the energy to do it, work on getting some help with addressing the fatigue. Fatigue can be caused by a number of things including hormonal imbalances and nutrient deficiencies. 

Food is a big deal. It’s a source of nutrition as well as joy and comfort. Don’t beat yourself up if you can’t craft your diet into a state of complete perfection (which is defined differently by everyone anyways). If you struggle with exploring a new way of eating that you’re interested in, rather than berating yourself for not having enough willpower, address the barriers that are getting in the way.  

Vitamin B12: What You Should Know

Having enough B12 can make a big difference in how well you feel. Here are some quick facts about vitamin B12 that you should know about. Knowledge is power - especially when it comes to your health.  

Dietary Sources

Animal protein like fish and meat

Dairy and eggs

Fortified foods and drinks (e.g. some soy-based meat substitutes and beverages)

Signs and Symptoms of Deficiency

Note: you don’t have to have all of these symptoms to have low B12 levels (you don’t even have to have any of these symptoms).

Fatigue

Abnormal CBC results with blood work – this is often the first way that a B12 deficiency is discovered

Heart palpitations

Tongue inflammation

Pallor  

Changes in the skin like loss of pigment or darkening  

Potential impacts on fertility

In more severe cases it can affect the nerves (numbness, tingling), cognitive function and memory

Who’s Most at Risk for Deficiency

Note: Even if you don’t check off anything on this list, you could still have a deficiency. Also, being at risk does not mean you will definitely have a deficiency.

Patients with stomach and colon issues (e.g. surgeries, auto-immune gastritis, inflammatory bowel disease)

Those using certain medications: metformin, some medications for GERD or stomach ulcers

Vegans and vegetarians

Adults over 50-75 years old

Patients with an H.pylori infection

Testing and Results

The “normal” level for B12 varies widely between countries and even depending on which lab you go to! Anything below 150-220 pmol/L could be considered low. But sitting right at the bottom of the normal range doesn’t feel great for many people. I usually like levels to be comfortably above the low end of the reference range.   

Testing B12 isn’t excessively expensive. If your MD tests it, it’s usually covered by OHIP. If I test it, it’s either covered by your workplace/ private health insurance or it’s around $20 out of pocket.

Note that measuring B12 in the blood isn’t a perfect science. If your levels are normal or low-normal but a deficiency is still suspected, other testing may be warranted to confirm deficiency (i.e. testing methylmalonic acid or homocysteine). This extra testing is on the pricey side.  

Supplements: Oral Versus Injection

In many cases oral supplementation is just as useful as injections. But injections can have faster results and some people only seem to respond to injections. I wouldn’t consider injections as first line in most cases.  

I’m all about getting our nutrients from the diet over supplements but in the case of B12, absorption is often better via supplements than food. So if you’re deficient, supplements may be the way to go. Many B12 products come in a form that you dissolve under the tongue. We don’t know for sure if this is better than swallowing the pill.  

How Long Until You Feel Better?

Many patients feel better within a week of taking B12 but just because you don’t, doesn’t mean you should stop taking it. It can take several weeks (even a couple months) for CBC blood test results to normalize and for symptoms to improve.

For a free list of foods linked to lowering anxiety, click the link below.

My Approach to Gluten

It’s a common cliché to think that naturopathic doctors put all their patients on a gluten free diet. The term gluten describes specific proteins in plants like wheat, rye and barley. Gluten gives foods made from these grains a unique texture that is hard to mimic. This is why gluten-free breads taste so different from the breads we’re used to.

I don’t believe everyone needs to be on a gluten free diet and I only recommend it when I think it’s necessary. I also don’t believe that only those with celiac disease need to consider reducing gluten intake. There is a growing body of research on non-celiac gluten sensitivity although this research is still controversial right now. Wheat and gluten sensitivities have been associated with skin conditions like eczema, irritable bowel syndrome, chronic pain and even mood disorders.  

I’ve seen a number of patients benefit from a trial of reducing gluten in their diet – even if they were already eating a healthy diet before. Personally, when I include gluten in my diet, I tend to get hives, seasonal allergies, my thyroid levels go out of whack, I get more fatigued, more “brain fog”, my mood suffers and I sometimes get mild joint pain. When I remove or even just reduce gluten, these symptoms all go away and I usually feel great.

It’s important to note that whenever I reduce my gluten, I try to avoid processed gluten free foods. A lot of these processed gluten free foods are not nutritionally valuable. I’ll have gluten free bread or gluten free treats here and there but for my staples, I prefer to stick to foods that are minimally processed and naturally gluten free like rice, sweet potato, quinoa, chickpeas, etc.

My latest gluten free stretch of time was 2017 - 2018. I was able to be almost gluten free for a big chunk of the year. I didn’t really miss it at all. However, towards the end of 2018, I started to feel deprived. As I mentioned in my article on intuitive eating, it’s really important to me that I eat healthy without feeling deprived. That’s why I decided to reintroduce gluten back into my life for now. I still try not to have it every day, but I am having it more than in 2017. The mild hives have returned, and I do feel a slight dip in my energy but I’m ok with temporarily paying this price so I can feel happy about my diet and less deprived. I know that in time I’ll be open to cutting gluten out again.

And that’s how it goes for me. I’m aware of my gluten intolerance and I fluctuate my level of gluten intake based on my motivation and sense of deprivation. My intolerance symptoms are mild enough that I can live with them when they come back. If they get more severe, then I might prefer to be more strict with my gluten avoidance.

The point is that the power is in my hands to use my awareness of my intolerance as I see fit. When I tell my patients that they may benefit from reducing certain foods in their diet, I will never sit there and judge them if they don’t follow my recommendations to a tee every single moment of their life. You have to know yourself and your relationship with food. You have to know what you’re willing to do and what you’re not ready for yet. I’ve had many patients tell me that they do want to change their diet but only to a certain extent. That’s ok. I will meet you where you’re at and we can change as much as you’re ready for and save the rest for another time.

My job is to arm you with the awareness of all the things that you can do to benefit your health. Your job is to communicate to me what you’re ready for and what you’re not ready for. Our job together is to use this information to build a plan that works for you on every level.

Burnout: Why it’s Absolutely Worth Treating

Burnout is a real problem in our society. More and more research is being dedicated to studying how burnout is affecting us and what we can do about it. Burnout often involves feeling completely exhausted, irritable and negative or cynical about your situation. This usually happens in response to constant, long term stress either at work or in other areas of your life. The load of responsibilities on you becomes too heavy and there is not enough time to rest and restore some sense of balance.  

When you’re in a state of burnout, you find it hard to do your job well and you struggle to give your all to your family and friends. Over time this can lead to low productivity, feelings of failure and increased conflicts with others. It’s important to know that physical health can be impacted as well. Burnout has been associated with headaches, chronic fatigue, bowel and stomach problems, high blood pressure and heart disease, catching colds more often, addictions and cravings, mental health conditions like anxiety or depression and poor sleep.

Those who are especially affected are people who work long hours, put themselves last and go the extra mile to support others. Many studies focus on health care providers being prime candidates for burnout. But let’s face it - it’s not just health care providers who are vulnerable to burnout. Parents, those with ill family members, entrepreneurs and anyone with a stressful or demanding job is susceptible.  

You may be thinking “yes it totally sounds like I’m experiencing burnout but it’s weird to see a health care provider for burnout. Doesn’t everyone suffer with this? Isn’t this just life? Am I going to see a doctor just because life is too crazy? What can they even do anyways? I’m overwhelmed with work, kids, chores, social events, personal and home projects. A doctor can’t take that away so what’s the point in treating it?”

It's true that I can’t take away many of the responsibilities that come with life. But it’s not about taking the responsibilities away, it’s about helping you have the stamina, resources and strength to cope with them better. I focus on the things that you can control like: nutrition, implementing key habits to soothe an exhausted body, herbs and supplements to give your system a helping hand and sometimes acupuncture which has been shown to reduce stress levels.

In fact, burnout has always been something that naturopathic doctors are quite good at treating. And if you are saying to yourself that you won’t have the time or willpower to follow through with recommendations, don’t worry – we can take baby steps and focus on what you are willing and able to change.

Decades of research have gone into studying burnout. If it’s that important to study then it’s that important to treat. It is possible to turn burnout on its head and get to the complete opposite state of burnout. That means feeling energetic, productive, positive, enthusiastic and healthy. No matter how overwhelmed you feel right now, there is always something that can be done to move you to a better state of wellbeing.

Ladies, Do You Have Symptoms of Low Testosterone?

When women think of their hormones the first thing they think of is estrogen. But testosterone plays a huge role in the well-being of every woman. High testosterone has a lot more attention than low testosterone. This is because it’s commonly known that high testosterone is linked to PCOS, acne, scalp hair loss and facial hair growth. Not many women know how having low testosterone can impact them.

Another name for low testosterone in women is “female androgen deficiency syndrome”. The most well-known symptom of this condition is low libido. However, not every woman with low testosterone has low libido. There are many other symptoms like:

- Low motivation

- Fatigue

- Depression

- Feeling generally unwell

- Osteoporosis

- Increased body fat

Low testosterone is most common in post-menopausal women. It can happen in younger women as well. It also seems to be common in women who are burnt out or experiencing something called “adrenal fatigue”. This could be because some of your testosterone comes from the adrenal glands. These are the glands that produce adrenaline and take a big hit when we’ve been stressed or overworked for too long.

More research needs to be done on this important syndrome and more women need to be aware of it. I test for low testosterone through blood or saliva tests. There are many herbs, nutrients and lifestyle protocols that I recommend to raise testosterone levels in women.

The transformation that you feel when your hormones are brought into balance is incredible and so worth the effort. I encourage you to learn more about all your hormones - including testosterone.

Hormone Testing with a Naturopathic Doctor

Hormone testing can be helpful in guiding treatment plans in some cases. It can tell you which hormones are higher than ideal, which ones are lower than ideal and which ones are normal. This can tell me which herbs, nutrients, dietary and lifestyle changes to recommend. Sometimes it’s obvious what needs to be worked on and we can skip testing. Sometimes it’s not as clear and testing provides guidance.

Cases that I may use hormone testing for are:

- Periods that are irregular and difficult

- Menopause that isn’t responding well to my usual treatments

- Challenging PMS cases

- Difficulty losing weight when there is a suspicion that hormones are involved

- Major fatigue, brain fog and other symptoms when there is a suspicion that hormones are involved

There are different ways that I test hormones. One way is the usual blood test that most family doctors do as well. Another other option is to test saliva. There are pros and cons to both.

Blood Tests

Blood hormone tests have been accepted by the medical community for longer than saliva tests. There is a good amount of research supporting them.

Some MDs and NDs have raised concerns about only relying on blood tests for hormones. Sometimes blood test levels and saliva levels line up with each other. Other times I find that patients with normal blood test levels have saliva levels that are not ideal. These saliva levels often match with the symptoms the patient is experiencing.

Saliva Tests

In order for hormones to enter saliva, they may need to travel into cells/ tissue first. This may not be the case for hormones in the blood stream. Some think this means saliva better reflects the levels of hormones that are actually acting on your cells/ tissues. I won’t be able to explain all the biochemistry here. You should know that research on saliva testing is still ongoing. Opinions on it may change in the future.

Insurance Coverage

It used to be that tests run by naturopathic doctors were not covered by insurance companies. Lately, more insurance companies have been covering testing. The only way to know for sure is to contact your insurance company and ask.

If you need some help managing your hormones book an appointment or free 15-minute consult today.

Common Causes of Fatigue

Fatigue is one of the most common complaints I hear about. When I ask patients to rank their energy on a scale of 1 to 10 most people hover around 5 and would like to see their number go up. Fatigue could be a symptom of a huge range of causes from mild to serious. Today I’ll talk about some of the common causes that I see.

The Basics

Some causes of fatigue are simple to spot on a blood test. Examples are:

- low iron

- hyperthyroidism

- hypothyroidism

- low B12

Another basic cause of fatigue is poor sleep quality. This includes issues falling or staying asleep. This is an area that I like to work on with any fatigued patient.

Hormonal Health

Hormone fluctuations or imbalances can lead to fatigue. Some common examples are thyroid dysfunction, menopause and premenstrual syndrome. Other cases are more subtle. You may have completely irregular cycles or painful cramps but no specific diagnosis. Sometimes getting hormones back in balance can help with fatigue in these cases.

Adrenal Health

Naturopathic doctors talk a lot about a type of fatigue called adrenal fatigue. I like to call it burnout. The adrenal glands produce the "stress hormone" cortisol. The theory is that being stressed and busy all the time can push the adrenals to work too hard. Eventually they get overtired and you feel that as an energy crash. With adrenal fatigue, you feel tired but wide awake at bedtime. You feel irritable, frazzled or depressed. Your gut may be acting up and you may be experiencing cravings and weight gain. You also may find that you get sick all the time – or every time you’re on vacation.  There’s more to the theory but I’ll dig into it in a future article.

Gut Health

Poor gut health can contribute to fatigue. This includes diarrhea, constipation, bloating, heartburn or anything else that involves the gut.  A healthy gut means better nutrient absorption. It also means better elimination of toxins and waste products and improved vitality. Food sensitivities and poor diet have also been linked to fatigue.

Immune Health

Most autoimmune conditions are associated with fatigue. Some common examples are rheumatoid arthritis, Hashimoto's disease and Graves' disease. Hyperactive immune systems (think allergies and asthma) can also be associated with fatigue. Balancing the immune system is an important part of my treatment plan in these cases.

Mental Health

A less commonly discussed cause of fatigue is mental health conditions. Depression and even anxiety can significantly zap someone of their energy. It's important to address these causes of fatigue when needed. Treating these can improve fatigue more than any quick-fix energy boosting supplement could. 

Fatigue is frustrating and getting a handle on it can improve your quality of life in so many ways. If you need help with your fatigue book an appointment or free 15-minute consult today.