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What should women eat for fertility?

December 17, 2018
female fertility diet, toronto naturopath, naturopathic doctor toronto, fertility naturopath

It might come as a surprise that few people think about preconception health. And to be honest, when they do, it’s usually because of fertility struggles. Diet plays a huge role in how we feel and function, and provides the necessary building blocks to support conception.

Carbs and Fertility

Carbs might make up a significant part of your diet. When it comes to nutritional science, there’s a lot of learn about carbs, but I want to focus on 2 things: the glycemic index and glycemic load. 

The glycemic index is a value assigned to a particular food on how fast or slow it causes an increase in your blood glucose level.

The glycemic load combined quality and quantity of carbohydrates. It’s calculated by the amount of food you eat and the glycemic index of the particular food.The glycemic load is also associated with higher risks of ovulatory infertility.

In PCOS, it’s been found that women will often consume foods with a higher glycemic index. When women reduce their carb intake (or perhaps choose carbs with a lower index and load), their insulin sensitivity will improve, testosterone will decrease, and ovulation will occur (this is important, because anovulation is a key symptom in PCOS).

Fats and Fertility

Let’s clear something up. Fat isn’t bad. Yes, some are better than others and there are some you should avoid completely. But you need fat to make hormones, help your eggs mature and to get that tiny blastocyst to implant! 

Unsurprisingly, you should be avoiding trans fats. They increase insulin resistance, may prevent ovulation from happening, and decrease your chance of getting pregnant.

To get into specifics, omega 3 fatty acids are associated with progesterone production in the luteal phase (this is important!) and a reduced risk of anovulation. In women undergoing IVF, omega 3 fatty acid intake was associated with better embryo morphology. 

Protein and Fertility

You should be eating at least 1g of protein per kg of body weight (more if you’re active). Protein comes in different forms: animal and vegetable. One study showed that ovulation was negatively affected by increased animal protein. While another study showed that although fish, eggs, and processed meats didn’t have an effect on ovulation, vegetable protein intake decreased anovulation. Blastocyst formation in assisted reproductive technology decreased in patients consuming more red meat. But it was positively affected by fish consumption.

Now before you head on off to the local fish monger, you want to pay attention to fish and mercury content (as it may interfere with hormones and fertility). Fish to avoid would be bigeye tuna, king mackerel and swordfish.

Soy protein often gets a bad rap, but can actually be beneficial in women seeking fertility treatments. Soy isoflavone supplements were associated with improvement in reproductive outcomes, increased live birth after clomiphene administration, and higher endometrial thickness and ongoing pregnancy rates after IVF and ICSI. 

A couple things to consider before ordering your soy latte – choose organic, non-GMO soy. And if you have a thyroid condition, it’s best to avoid dietary soy altogether.

Next Steps

It might be obvious that a diet that leans towards fast food/processed foods and few fruits and vegetables is probably not the best. And when it comes to a diet in particular, adopting a Mediterranean diet (which basically has a foundation of vegetable and fruit, whole grains and fish) has shown to be effective in a few studies. 

Pesticides and other chemicals in our foods may also affect reproductive success, so if possible, choose organic when you can. Basically, if any of the fruits and vegetables that you eat appear on the Dirty Dozen, eat the organic version instead. 

When choosing meats, aim to get your meats from local farms if possible. And grass-fed and antibiotic-free are great options too. 

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References

Chiu, Y., Chavarro, J. and Souter, I. (2018). Diet and female fertility: doctor, what should I eat?. Fertility and Sterility, 110(4), pp.560-569.

Why am I getting acne now that I’ve stopped birth control?

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January 9, 2018
acne birth control, toronto naturopath, naturopathic doctor toronto

You started birth control years ago to deal with acne. 

Now you’re thinking it’s time to stop for good. 

But you’re worried that you’re going to start breaking out again. 

Does this sound familiar? You’re not alone. This is (unfortunately) a common thing that many people struggle with. Let’s figure out why this happens and what you can do about it!

Why does acne happen?

When  we start puberty, a bunch of our hormones get activated – estrogen, progesterone, androgens, etc. Sebum production increases from about 9 years old to 17 years old. Hormones like testosterone can trigger acne because it increases sebum production.

Birth control and testosterone

Birth control pills have a couple of effects on hormones:

  • Decrease androgens like testosterone, DHT and DHEA-S
  • Increases SHBG
  • Decrease serumproduction

The progestins used in birth control are actually pretty structurally similar to testosterone, and can therefore produce androgenic side effects. However the side effects are based on how ‘androgenic’ the progesterone is – this is known as the androgen index.

Progestins with a high androgen index may cause can cause acne, hair loss, weight gain, and insulin resistance. These progestins include: medroxyprogesterone acetate, levonorgestrel, norgestrel, and etonogestrel.

Progestins with a low androgen index may cause depression or anxiety, low libido, and suppress adrenal function. When you stop taking this type of progestin, your body may rebound by producing a lot of androgens because it doesn’t think any are available. These progestins include: drospirenone, norgestimate, cyproterone, and natural progesterone.  

Your skin on birth control

You might have noticed that when you started birth control, your skin became clearer. That’s because the hormones in the pill (estrogen and progestin) suppress androgens (like testosterone) and ultimately sebum. When your sebum levels are low, your skin will make more sebum to compensate. The estrogen and progestin will continue to suppress sebum production, and the cycle will continue on.

You’re probably not worried about this when you’re on the pill, because you’re not noticing any of it. Your skin is clear, your selfie game is strong, and you are able to get throughout the day without any embarrassment or frustration.

Your skin off birth control

At some point you’re going to want to get off the pill. Maybe you’re thinking of starting a family, maybe you want to experience a real period – whatever the reason is, you’re worried about what’s going to happen with your skin.

Because I believe honesty is the best policy – it’s important to know that you’re probably going to get acne once you stop the birth control pill.

Why does this happen?

It happens because sebum is not being suppressed anymore, and you have higher levels now than when you did when you started the pill. And because your ovaries are producing androgens again (another group of hormones that are effectively shutdown when you take birth control).

For the next 6-12 months your body is going to be withdrawing from the effects of the pill, which means that acne may be on the horizon for you.

Prepping your skin before you stop the pill

If you want to stop the pill, then consider prepping your skin about a month before you give the pill up for good.

Dairy-free diet

Cow dairy may cause inflammation and produce chemicals that increase inflammation and sebum production. This is especially seen with skim/non-fat milk products and ice cream. Dairy also contains hormones that can affect the body, by producing more testosterone.

Consider switching to alternative forms of dairy, or even choosing different animal dairy like buffalo (my fave), goat or sheep dairy. 

Sugar-free diet

Refined sugars may increase insulin, which can increase androgen production in the body. Plus let’s be honest, processed foods aren’t great sources of nutrients. If you can do better, choose better. 

Fix your digestion

Acne may pop up with leaky gut and food sensitivities. Normally whatever enters your gut, should (momentarily) stay in your gut. But if you have leaky gut, food from your gut may pass through some cells it shouldn’t, and end up elsewhere in your body. Your immune system will respond by mounting an attack against these food particles and cause a cascade of effects – acne being one of them.

So if you’ve cut the dairy and sugar for a couple of weeks, but are still experiencing acne – you may want to give the elimination diet a try.

Consider supplements

Supplements can be great at quick starting the healing process (especially since the pill depletes a bunch of nutrients). Ultimately, you should consider working with a health professional when supplementing because we make sure you’re taking the best product, dose, form and timing.

Some nutrients to consider are:

  • Zinc
  • Berberine
  • DIM
  • B vitamins

Go deeper

Acne may also be a sign of PCOS. Now before you tell me you don’t have polycystic ovaries (I hear this a lot), you can have PCOS without the cysts.

If you have irregular periods or don’t ovulate and have signs of high androgens (ex. acne), then it’s worthwhile to get some testing done. Check out my in-depth series on PCOS to learn more.

Next Steps

While the prospect of getting acne once you stop the pill is both frightening and frustrating (especially if you’re an adult), there is hope! Starting a skin-care plan before you stop is a step in the right direction.

And working with a professional can help you navigate all the ups and downs –particularly if you’re working with food sensitivities or PCOS. If you have any questions or tips and tricks, please share them below!

Endometriosis in Teens

December 10, 2018
endometriosis in teens, toronto naturopath, naturopathic doctor toronto, teen naturopath, danforth naturopath

It’s time to listen to your body. 

Especially if you’re experiencing period pain. 

You might’ve been told that period pain is normal. But that’s not exactly true. Period pain is a common symptom, but isn’t always normal.

Cramping in your lower pelvis or back is normal around the start of your period, but experiencing severe pain isn’t. If you feel a stabbing, burning, or throbbing pain that doesn’t go away with pain killers, and is causing you to miss school or work, and affecting your quality of life – you need to figure out what’s going on.

One of the emerging causes of period pain in teens is endometriosis. Endometriosis happens in about 10% of women who menstruate (likely more!). It was previously thought that teens didn’t have endometriosis because research only looked at older women who were having trouble getting pregnant.

What is endometriosis?

Endometriosis is a gynecologic disease that occurs when endometrial tissue grows outside your uterus. This tissue can grow anywhere in your body (it’s even been found on the lungs and brain), but it’s most commonly found on the ovaries, fallopian tubes, uterine surface, bowel and the lining of the pelvic cavity.

When you experience your monthly period, you also experience internal bleeding and ultimately scar tissue will form. Sounds great, right? #noway

Common endometriosis symptoms in adults

Some of the common symptoms associated with endometriosis are:

Other symptoms include:

How does endometriosis present in teens?

You might notice pain that doesn’t quite sync with your period (aka. noncyclic pelvic pain). Also, if your mom or sister have endometriosis, or if you have a history of atopic disease (ex. eczema, asthma) – you should be checked!

Endometrial lesions might be found between your ovaries, peritoneum, pouch of Douglas, uterosacral ligaments and rectovaginal septum. Typically, the lesions may present differently than they would in adults. Yours might be more red and clear. 

Because of these differences, this may contribute to your delay in diagnosis, and ultimately treatment. Obviously this lag may negatively impact your quality of life. 

Warning signs in teens

Pay attention to these signs:

  • Extended use of anti-inflammatory drugs (ex. NSAIDs)

  • Family history of endometriosis (ex. mom and sister)

  • Frequent absence from school during your period, and skipping exercise because of pain or a heavy flow

  • Birth control prescription before you turn 18 because of pain

How is endometriosis diagnosed?

You can’t diagnose endometriosis through a blood test. Instead, the gold standard of testing is a laparoscopic exam. This is considered a minimally-invasive surgery where small incisions are made in the abdomen to both confirm the presence of and remove endometrial lesions.

Doctors may suggest ultrasounds to see if you have endo, but that test can’t completely rule endo out. 

Conventional Treatment of Endometriosis

Unfortunately there’s no cure for endometriosis. But treatment should include controlling pain and preventing lesion progression. 

The first line treatment in endometriosis is birth control (usually a combined pill). This may actually be worthwhile to try if the pain is incredibly severe, and not responding to regular painkillers. Nevertheless, there are a few things to consider if you plan on taking birth control: 

A huge study in 2016 investigated different types of birth control and how they were associated with antidepressants and a diagnosis of depression. Researchers found that teens (between 15 to 19) are more sensitive to depressive symptoms and antidepressants than adults. This was seen in teens using the combined pill or progestin-only pill. The study did show that the incidence of depression and antidepressants use decreased with age. 

Teens with endometriosis report impaired physical and mental health quality of life. As well as physical pain, difficulty in participating in daily activities, physical activities, and social events. Therefore all of these factors must be considered when determining the best treatment route, or adjunctive supportive therapies. 

Naturopathic Treatment of Endometriosis

Once again there isn’t a cure for endometriosis, but you can do a couple of things to manage the pain and improve quality of life. There are some supplements that you can take, but it should really be done under the supervision of a health practitioner like a Naturopathic Doctor. 

You may want to consider:

  • FODMAPs diet or an anti-inflammatory diet

  • Curcumin

  • N-acetyl cysteine

  • EPA/DHA

  • Selenium

  • Vitamin E

Next Steps

If you’ve been experiencing any of the warning signs, it may be time to talk to your doctor about endometriosis. 

If you found this information helpful, I would encourage you to download my 
FREE EndoDiet meal guide and plan. It goes through everything we discussed: foods that are safe and that should be avoided, and a 7 day meal plan and preparation guide!

References

Dowlut-McElroy, T. and Strickland, J. (2017). Endometriosis in adolescents. Current Opinion in Obstetrics and Gynecology, 29(5), pp.306-309.

Gallagher, J., DiVasta, A., Vitonis, A., Sarda, V., Laufer, M. and Missmer, S. (2018). The Impact of Endometriosis on Quality of Life in Adolescents. Journal of Adolescent Health, 63(6), pp.766-772.

Reid, R., Steel, A., Wardle, J. and Adams, J. (2018). Naturopathic Medicine for the Management of Endometriosis, Dysmenorrhea, and Menorrhagia: A Content Analysis. The Journal of Alternative and Complementary Medicine.

Zannoni, L., Forno, S., Paradisi, R. and Seracchioli, R. (2016). Endometriosis in Adolescence: Practical Rules for an Earlier Diagnosis. Pediatric Annals, 45(9), pp.e332-e335.