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Preparing for Pregnancy

May 2, 2016
preparing for pregnancy, naturopathic doctor, toronto naturopath

Over the past few months my interest in fertility has increased. I’m at the age where many women get married and begin thinking about starting a family. Many people believe that taking folic acid, is the be all and end all of prenatal preparation. While folic acid is important, a healthy pregnancy goes beyond a prenatal vitamin. In fact, about 12 months should be spent preparing your body for pregnancy!

Know your cycle

Being intimate doesn’t always lead to a planned (or spontaneous) pregnancy. Especially since a woman’s cycle hits a sweet spot about mid-way through her cycle — known as the ovulatory period.  Women are fertile about 1-2 days before their ovulatory period. To establish this time, ideally a woman should be experiencing regular cycles. Cycles can be tracked a variety of ways, my favourite being the period tracker app as it will give you an indication of your typical cycles and can help you determine if anything is abnormal.

Nutrition

While supplementing with a good quality prenatal vitamin (without fillers, colours, and toxic compounds) is a great way to get the recommended daily intake of certain nutrients (like folate), focusing on a whole foods diet is key. Vitamins B, C, D, and E are important for female fertility in their own way, along with selenium, glutathione, cysteine, omega 3 fatty acids, CoQ10 and other minerals.

Body Weight

Many women of reproductive age are either overweight or obese (determined by the Body Mass Index). This can affect gestational age, C-section rate, birth defects, as well as the potential for obesity and diabetes in children (in adult age). Because obesity can lead to lower pregnancy rates, a BMI between 20-34 is recommended for reproductive-age women. Simple ways to help improve BMI is through nutrition by implementing a whole-foods and unprocessed diet, and through exercise. Similarly, women with low BMIs (under 19) may not be able to support a pregnancy due to low body fat.

Toxic burden

Many of our favourite fruits and vegetables contain pesticides (which can lead to a variety of health concerns including hormone disruption). The Environmental Working Group has prepared a list of popular produce items and divided some of them into Dirty Dozen and the Clean Fifteen to highlight what should purchased organic and what doesn’t need to be organic. Moreover smoking, alcohol and caffeine have been shown to also decrease fertility rate.

Blood tests

Make sure you go for your annual physical and have your doctor run a few lab tests, as iron and thyroid status may affect pregnancy outcomes.

What can you do if you’re looking to get pregnant within the next year?

  • Begin to chart your menstrual cycle to determine if it’s normal and to determine when you are fertile and ovulating. 

  • Consider taking a prenatal vitamin. Yes, there are tons of options at a drug store — but you want something that’s high quality and has active ingredients

  • Go for your annual physical and blood test – implement any changes if required. Are you overweight? Consider a whole food diet, begin to go for walks with your partner. Is your iron low? Increase it through diet or supplementation (looking for something that’s high quality)

  • Decrease your toxic burden. Which foods are you eating off the Dirty Dozen? Choose their organic counterparts. Do you smoke? Start your process of quitting.

Final Thoughts

About 1 in 6 couples in Canada experience infertility, and this number has doubled since the 80s! For women under the age of 35, infertility is considered if you’re unable to conceive after 1 year of trying. For women over the age of 35, infertility is considered if you’re unable to conceive after 6 months of trying. Many women don’t talk about their struggles and often seek advice through Dr. Google to determine what they can do and natural supplement to take to increase their chances. If you choose to go the natural route (and there are plenty of things you can do), speak to a healthcare professional who can provide you with the right information specific to you and your concerns. That’s something Dr. Google can’t do.

Postpartum Depression and Naturopathic Medicine

May 5, 2016
postpartum depression naturopathic medicine, toronto naturopath, naturopathic doctor pregnancy

Postpartum depression can only be treated with medication, right?

Wrong!

It can be approached holistically, if you have some time and patience. 

If PPD is not treated properly, it can affect your overall functioning. While untreated PPD may cause health and developmental problems in your baby, and to be honest, it can affect your whole family. 

May moms are reluctant to seek help when it comes to PPD because they’re unable to recognize their own mental health symptoms, and accessing care can be difficult. An easy screening tool that will help you determine is PPD is affecting you is the Edinburgh Postnatal Depression Scale.  

Many treatments for PPD are emerging. Antidepressants (ex. SSRIs) are commonly used as the first-line treatment, but do have a range of side effects that many moms hope to avoid. Furthermore, some moms discontinue taking their antidepressants because they worry about transmission into breastmilk. 

Naturopathic treatments often focus on how PPD symptoms are affecting your quality of life, but also aim to discover the underlying cause of postpartum depression.

When I work with women who have PPD, my treatments can range between dietary and lifestyle changes, counselling, acupuncture, botanical medicine, and more! I give you all the info, but it’s up to you to determine what you have time for. 

Holistic Treatment of Postpartum Depression

Lavender and Postpartum Depression

A study was conducted on the effects of lavender during the postpartum period. Mothers in the intervention group applied lavender essential oil on their palms and rubbed them together throughout the day and inhaled the lavender scent. They did this for 4 weeks post-birth, and were followed up at the 2 week, 1 month, and 3 month mark (post-birth) using the EPDS. Results demonstrated that although stress and depression rates naturally decrease after birth, the decrease was higher in the lavender group.

Iron and Postpartum Depression

Many women go into pregnancy with low iron levels. It’s not a surprise considering that an iron deficiency is the most common nutritional deficiency in women – thanks to our period! Plus ferritin (the storage form of iron) has an optimal level. Which means that even if you fall within the ‘normal’ range, your stores may not be optimal. 

When you’re pregnant, your body needs more hemoglobin (as your blood volume is increasing), so it shouldn’t be a surprise that you need more iron! Blood loss after birth (ex. postpartum hemorrhage and c-section) may also cause iron stores to decrease. 

It seems like the odds are stacked against you, right?

A recent review examined the effect of iron deficiency and postpartum depression. Eight out of ten studies found higher risk for PPD in anemic women. Women who had low ferritin in the postpartum period (not pregnancy) was associated with an increase risk in PPD. Giving iron in the postpartum decreased PPD risk. 

For example, one study showed that supplementing iron in moms with PPD improved depressive symptoms. Mothers experiencing PPD (based on the EPDS) 7 days after delivery were supplemented with iron. After 6 weeks, the mothers took the EPDS again to determine if anything changed with supplementation. Results demonstrated that mothers who supplemented with iron had a significantly lower EPDS score compared to placebo.

So what does this mean for you? Well, you should get your ferritin levels checked before pregnancy, but definitely after pregnancy. Working with a ND, will help determine how much iron you should be taking, when, and the best form (because I’m sure you don’t have time for constipation). 

Vitamin D and Postpartum Depression

Low vitamin D status was shown to be associated with postpartum depression, compared to women not suffering from postpartum depression (as measured by the EPDS). Because vitamin D can be protective, it’s imperative that serum levels are measured during pregnancy and supplementation is done as required.

Omega-3 and Postpartum Depression

A deficiency of omega-3 fatty acids during pregnancy and lactation is considered a risk factor for PPD. It is thought that supplementing with EPA-rich oil during pregnancy can reduce depression and PPD once your child is born. Taking only DHA may help with reducing PPD in women who are not breastfeeding. DHA does help build a healthy brain in children, so if you are supplementing – be sure to choose a formula with both EPA and DHA. 

Acupuncture and Postpartum Depression

New evidence is showing that acupuncture can be helpful when it comes to PPD. I personally love acupuncture for everything, but huge barrier is carving out the time to get a 30 minute treatment. Nevertheless, it’s an option and perhaps something to have done if you have help with childcare.

Acupuncture is more than just inserting needles in different areas in the body. It’s thought to influence your neuroendocrine and immune systems through regulating different neurotransmitters like serotonin, dopamine, endorphins and glucocorticoids. It can regulate gene expression and new research is suggesting that it may actually have antidepressive effects. 

While we don’t know the true cause of PPD, it’s thought that a drop in hormones, specifically estrogen, can lead to depressive symptoms. A 2018 review showed that in 4 studies, estrogen levels increased after acupuncture. 

If acupuncture is something that you might consider trying, book an appointment with a Naturopathic Doctor or Licensed Acupuncturist. The way they use acupuncture, may be a bit different than a Chiropractor or Physiotherapist.  

Sleep and Postpartum Depression

In case you are reading this before you give birth, now is the best time to rest and get all your sleep in. A study showed that prenatal sleep disorders in pregnant women may actually increase the risk of developing postpartum depression. There are many remedies out there that can help with sleep for instance acupuncture, magnesium, and even balancing your blood sugar before bed!

When dealing with lack of sleep post pregnancy, you may want to consider supporting your adrenal glands, evaluating your breastfeeding expectations (especially as your baby gets older), and seeking help when needed (ie. partner, family, doula).  

Breastfeeding and Postpartum Depression

Breastfeeding has been associated with positive maternal outcomes. Despite experiencing many stressors upon giving birth, breastfeeding protects mothers as it induces calm feelings, decreases stress, and increases nurturing behaviour.

Yoga and Postpartum Depression

Yoga has been shown to be a complimentary therapy for mothers experiencing PPD. Depressive symptoms were assessed using the Hamilton Depression Scale. Mothers in the yoga group practiced twice a week for 8 weeks and improved at a significantly faster rate on measures of depression, anxiety, well-being, and health-related quality of life.

Cognitive Behavioural Therapy (CBT) and Postpartum Depression

Cognitive behavioural therapy will identify negative thinking patterns and assess the link between thoughts, feelings, and behaviour. When you experience depression, you might experience negative thoughts that carry significant meaning. This meaning might be relation to the past, future, about yourself or your world.

CBT helps you change thee negative thoughts, so ultimately you can change how you view and feel about yourself, and change your behaviour. 

A review looked at CBT in moms with PPD and found that 7 practices were commonly used in treatment – pyschoeducation, thought restructuring, problem-solving, behaviour management, goal setting and achieving, stress management, and relaxation. The most common were psychoeducation and challenging negative thoughts and beliefs. While CBT was found to be an effective treatment for PPD it can be time consuming and may require adjunctive childcare. 

Next Steps

You don’t need to go through PPD alone! Check out the Canadian Mental Health Association website for more information about PPD, or book an appointment with a Naturopathic Doctor start implementing the best therapies for you, so you can feel great again!

References

Li, S., Zhong, W., Peng, W. and Jiang, G. (2018). Effectiveness of acupuncture in postpartum depression: a systematic review and meta-analysis. Acupuncture in Medicine, 36(5), pp.295-301.

Polmanteer, R., Keefe, R. and Brownstein-Evans, C. (2018). Trauma-informed care with women diagnosed with postpartum depression: a conceptual framework. Social Work in Health Care, pp.1-16

Schiller, C., Meltzer-Brody, S. and Rubinow, D. (2014). The role of reproductive hormones in postpartum depression. CNS Spectrums, 20(01), pp.48-59.

Sheikh, M., Hantoushzadeh, S., Shariat, M., Farahani, Z. and Ebrahiminasab, O. (2015). The efficacy of early iron supplementation on postpartum depression, a randomized double-blind placebo-controlled trial. European Journal of Nutrition, 56(2), pp.901-908.

Stamou, G., García-Palacios, A. and Botella, C. (2018). Cognitive-Behavioural therapy and interpersonal psychotherapy for the treatment of post-natal depression: a narrative review. BMC Psychology, 6(1).

Wassef, A., Nguyen, Q. and St-André, M. (2018). Anaemia and depletion of iron stores as risk factors for postpartum depression: a literature review. Journal of Psychosomatic Obstetrics & Gynecology, pp.1-10.

Female Friday

October 7, 2016

fertility friday, fertility, bloor west, toronto, naturopathic doctor, naturopathic medicine, alexsia prioloThis time last year I was in Europe on my honeymoon. I wish I was exploring Lisbon’s hidden gems, driving between Berlin and Munich and counting all the windmills on the way, or eating another lemon sorbet in Monterosso – but alas, I am studying for yet another exam. A few years ago I started up Friday Five, a curation of different links I enjoyed over the week. This reboot called Female Friday, is going to specifically focus on women’s health because I want you to be well informed with everything involving you and your lady parts.

Figuring out when you’re fertile / Check out my latest video to figure out when you’re ovulating during your cycle.

Menstrual Cups Revival / I’m not the only one who listens to podcasts during my commute, right? Why I didn’t do this during my 10+ years of riding the TTC I’ll never know, but now is better than never. Stuff Mom Never Told You is one of my favourite podcasts, and I was so happy that they discussed menstrual cups. What I found most interesting was that the cups has to be marketed to the midwife/vegan/alt med practitioner first because other women weren’t likely to try it. Which is true in my personal experience! When I was at York, the sexual health team (of HealthEd) was giving away TONS of these and at that point in my life – I was 100% NOT interested. Even during Naturopathic Medical school I went back and forth on the decision to try. I caved last year, bought one, and never looked back!

Does the birth control pill cause depression? / It’s true, hormones can affect your mood. I’ve read the study which was in JAMA Psychiatry and it seems pretty robust. The authors did note that the women not taking any form of contraceptive, were also at risk for being diagnosed with depression or prescribed an antidepressant. The most concerning part was that teenage girls were more sensitive to depression than women aged 20-34. I’m interested in knowing how many teenagers are going on the pill to prevent pregnancy, versus going on the pill for other reasons such as painful periods, heavy periods, acne, etc. Because if we can treat these underlying period problems, what effect will that have on women and depression.

What men need to know / I remember teaching my husband about periods when we were in high school. I’m not sure how many men retain that information, but it is important for them to know. While they may or may not want to know about the follicular phase or luteal phase, it is important to both of you to know about ovulation.

Clue / After learning that my favourite period tracker was sharing my information with 3rd parties, I’ve decided to test out another period tracker app. Clue interested me the most because it has a great website with tons of information and it was created by a woman (which I’m always happy to support!). It’s much less pink and flowery and more minimalist (which I love!). I wish I could import over 2 years worth of period info, but c’est la vie. Let’s see how this one flows (get it?).

Naming your period / Does your period have a name? Or should I say, does it bother you enough to warrant a name?